Twisted Tea Party Registration Form

Instructions:

1. Create your entry materials (a rough sketch and a brief project explanation).
2. Email (preferred): Construct a PDF (with Adobe Acrobat software) or RTF (rich text format, use Save As... in MS Word if needed). Include the information on this form and your entry materials. Email it to: lolita@pacificmediaexpo.com by October 18, 2006.
3. Snail mail: Print, fill out, and mail in this form (with your entry materials attached) by first class mail so that it is postmarked by October 18, 2006, to ensure that we have at least a few days to process it before the convention.

Twisted Tea Party
c/o Pacific Media Expo
909 Marina Village Parkway, PMB 660
Alameda, CA 94501

All fields are mandatory except for additional names at the bottom.

Group name (Please include pronunciation notes for the Japanese impaired):

______________________________________________________

Project name: ___________________________________________

Project description: _______________________________________

_______________________________________________________

_______________________________________________________

_______________________________________________________

How many people total will be participating in your project? ___

Are there any minors in your group? ____ If so, how many? ____
*Note: For each minor, the participant's parent or legal guardian must write a note giving permission.

Full name of your group's primary contact:_______________________

Address, Phone number, and E-mail address of primary contact:

Address: _________________________________________________

_________________________________________________________

Phone__________________ (Cell? Y/N) Email: ___________________

Participants (This includes primary contact):

1. Name: _____________________
2. Name: _____________________
3. Name: _____________________
4. Name: _____________________
5. Name: _____________________
6. Name: _____________________