Name *

First Name

Last Name

Participant's Date of Birth *

MM

DD

YYYY

Phone Number *

(###)

###

####

Entry Theme *

Anime

Manga

J-Rock / J-Pop

Asian Video Game

International

Other (Please list in "Additional Info" section)

By entering the Anime Magic! Cosplay Contest, I give permission to Anime Magic! and its designees to photograph and/or video tape my costume and performance, to use these photographs and/or video tape as the convention sees fit. I also attest that I am eligible to compete as per the Anime Magic! Cosplay Contest rules and that all information on this entry form is true and correct. I also, hereby, acknowledge that I, as the primary contact for this entry, and my group, if in one, will be asked to sign a paper copy of this form at the Cosplay Contest check-in at the Convention. I also understand that if I, and my group if in one, do not sign, my entry will be disqualified and not be allowed to go onstage. If I or any member of my group is under 18, I understand that I/that group member must have a legal guardian sign the paper copy of this form at the convention. By submitting this entry form, I acknowledge that I have read and understood the rules and guidelines established and posted by Anime Magic! *

I agree

I disagree