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
Children age 6-12
Young Adults age 13-17
Adults age 18-20 and College Students
Teachers and Library Staff
Military Personnel and Family
Member of San Diego Fan Group
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