PERFORMER REGISTRATION 2018
Completing and submitting this application is not a guarantee of space or placement.  This application shall not be a binding contract until this page of the application has been signed by both the performer and an authorized representative of ANIME IMPULSE.
* Required

Name *
Name
Address *
Address
Phone *
Phone
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Acknowledgement *
I have read and understand the general terms and conditions and understand that filling out this application is not a guarantee of a performance.