Contact Information
Please provide us with your first and last name as on your government issued photo ID for sign-in purposes.

First name:

Your legal given name as on government issued ID

Last name:

Your surname as on government issued ID

Preferred name:

How would you like to be addressed?


A valid email address so we can contact you


Your preferred phone number

Event Information
Event Name:

Your event name or title

Event Type:

What is your event format?


Please refer to Appendix A in the Panel Guidelines for rating descriptions


How long will your event run in minutes? To the nearest 15 minutes

Est. Attendance:

Have you hosted this panel before?, If yes, what was the approx. attendance?

people (approx)

Detailed Description:
Please provide a detailed description of your event for internal non public use. If you are submitting a panel rate MP, further information may be requested from you. Required

Short Description (150 characters max):
Please provide a shorter description of your event for the guidebook and other public use. Required
Co-Panelist Information
If you have a co-panelist please provide their details here. One co-panelist only please.


Do you have a co-panelist (one) assisting you?

Yes No

Additional Information
We will NOT provide laptops. Panelists are expected to bring their own equipment (please submit specifics in the Detailed Descriptions box above for approval).

Setup help:

Request Tech Assistance for setup at Convention?

Yes please No thanks
Audio required:

Audio (for any device with audio-out)

Yes please No thanks
Video required:

Video (HDMI/VGA devices)

Yes please No thanks
Room type:

Room type not guaranteed, but we will try our best to accommodate

Another panel:

Are you involved with hosting more than one panel at this event?

Yes No

Additional Information:
Anything else you'd like to add to assist us in our assesment of your event?
Availabilty Information
Your availability:
When would you be able to hold your panel? Morning is 10:00 AM to 12 noon, afternoon is 12 noon to 5:00 PM and evening is 5:00 PM to close
Friday: Morning Afternoon Evening All Day
Saturday: Morning Afternoon Evening All Day
Sunday: Morning Afternoon Evening All Day
Signature of Event Host
By checking this box, you agree to abide by all Animethon policies polices and have read, understood and agree to abide by the Panel Submission Guidelines and Rules.

Once your submission is received, a confirmation email will be sent to the email provided above. Please review to ensure all information provided is correct.

If you need to correct any information on this form, email Do not resubmit this form. Thank you.

The event reserves the right to edit/modify descriptions and panel titles as required.


Please type your name

Date: 2017-04-28

Required We require this information in order to proceed.
Recommended While we do not require this information it would definitely assist us which could in turn help you.
Optional We do not require this information but we may find it helpful.