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

Required
Last name:

Your surname as on government issued ID

Required
Preferred name:

How would you like to be addressed?

Optional
Email:

A valid email address so we can contact you

Required
Phone:

Your preferred phone number

Required
Event Information
Event Name:

Your event name or title

Required
Event Type:

What is your event format?

Required
Rating:

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

Required
Duration:

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

Required
Est. Attendance:

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

Recommended
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.

Co-panelist:

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

Required
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?

Required
Yes please No thanks
Audio required:

Audio (for any device with audio-out)

Required
Yes please No thanks
Video required:

Video (HDMI/VGA devices)

Required
Yes please No thanks
Room type:

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

Optional
Another panel:

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

Required
Yes No


Additional Information:
Anything else you'd like to add to assist us in our assesment of your event?
Recommended
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
Required
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 live@animethon.org. Do not resubmit this form. Thank you.

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

Signature:

Please type your name

Required
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.