Username/Login:

Password:

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

Registration Status: I have pre-registered I will pre-register I will register at the door

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

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

Phone Number:
Cellphone Number:
Email Address:

Age: 18+ 16-18 0-15

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:

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.)