Anime-Conji Online Membership Form
Please provide the following information:
First Name
Middle Init.
(Optional)
Last Name
Badge Name (optional)
Address:
(cont'd):
City:
St:
Zip:
Contact E-mail:
Contact Phone:
How did you hear
about Anime Conji?
What fan group
are you with?
Rate:
Regular Pre-Registration
High School Student / Faculty
College Student / Faculty
Military
Librarians and Library Staff
San Diego Fan Group
Friday Only
^M
Saturday Only
^M
Sunday Only
^M
Child, Age 6
Child, Age 7
Child, Age 8
Child, Age 9
Child, Age 10
Child, Age 11
Child, Age 12
Child, Age 13
Child, Age 14