Registered Name:
(This is the name you will use to register for Anime North, aka your legal name.)

Name to be used in program book, panel introduction, and communication:
Name on the Teahouse of the Maple Moon forum: (if applicable)

Mailing Address:
City: State/Province: Postal Code: Country:

Phone Number:

Cell Number:
E-mail Address:
(Do you agree for this address to be handed over to other panelists: Yes No
This will allow better preparation. If it's an issue, add a note in the comments.)

Age: 18+ 16-18 0-15

Panels That You'd Like to Speak On:
(List in order of Preference. 5 for a full membership refund.)
Panel ideas can be found here or feel free to suggest your own.
1.
2.
3.
4.
5.

Do not list panels for any of the subsections listed below in the spaces above. Space for these panels will be provided later.
I would like to register for Doll North panels as well.
I would like to register for Yaoi North panels as well.
I would like to register for Cosplay panels as well.

I Have Done Panels at Anime North Before: Yes No
If so, which ones:

I Have Done Panels at Another Convention Before: Yes No
If so, where:

(If none of the above apply, and you'd still like to try it, add in relevant experience in the comments section.)

I Have Moderated a Panel Before: Yes No
If so, where:

I Will Not be Available for Panels During:
(Specify exact dates/times or events.)

I Would be Available for Panels at Other Conventions in Toronto: Yes No
I Would be Available for Panels at Other Conventions in Ottawa: Yes No
I Would be Available for Panels at Other Conventions in Montreal: Yes No
I Would be Available for Panels at Other Conventions in Western New York (Rochester/Buffalo): Yes No

Comments: