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Pre Registration Form

When filling out the name sections of the form, please use the name that will be on your license or ID when you pick up your convention badge.

Pre Registration. Price good 2/ 1, 2022 - 5/ 31, 2022 ages 13 and older. . .$55

VIP Sponsor Level Registration. Price good 12/1, 2021 - 5/31, 2022. . .$150

Child Badge, Ages 6-12, (age is based on the first day of the 2022 Convention). Price good 11/26/2021 - 5/31/2022. . .$15

Number of registrations on this form *

Person One - Person One

Last Name *

First Name *

Middle initial *

Badge name *

Limit of 24 characters including spaces. No 18+ words or references. If we have to change your name we WILL get creative!

Physical Address *

Address Line 1

City

State

"Snail Mail"

Zipcode *

Phone *

Must be the main contact number. For Children 12 and under list the number of the parent.

Email address *

Email

Confirm Email

AnimeIowa Email List *

YES!!
no

Birthdate *

All attendees under the age of 13 must have a registered Adult 18 and over with them at all times.

Age on 7/22/2022 *

6-12 years old. Birthday between 7/22/2016 and 7/21/20106
13 to 17 Years old. Birthday between 7/22/2010 and7/21/2005
18 Years and older. Birthday on or after 7/22/2005

Age will be cross referenced with birthdate.

Registration level *

Teen/Adult - $ 55.00
Sponsor - $ 150.00

Registration level *

Child - $ 15.00
Sponsor - $ 150.00

Emergency Contact (if under 18)

If you were born after 07/30/2003 you must fill out the Emergency contact information below. You can not pick up your badge without this information being filled out. This person is the one we would contact if you were unable to communicate for yourself in case of accident or serious illness.

Contact's Full Name *

Relationship to Attendee *

Phone Number *

Must be the main contact number. For Children 12 and under list the number of the parent.

Person Two - Person Two

Last Name *

First Name *

Middle initial *

Badge name *

24 characters including spaces. No 18+ words or references. If we have to change your name we WILL get creative!

Email address *

Email

Confirm Email

Physical Address *

Address Line 1

City

State

"Snail Mail"

Zipcode *

Birthdate *

All attendees under the age of 13 must have a registered Adult 18 and over with them at all times.

Age on 7/22/2022 *

6-12 years old. Birthday between 7/22/2016 and 7/21/2010
13 to 17 Years old. Birthday between 7/22/2010 and7/21/2005
18 Years and older. Birthday on or after 7/22/2005

Age will be cross referenced with birthdate.

Registration level *

Teen/Adult - $ 55.00
Sponsor - $ 150.00

Registration level *

Child - $ 15.00
Sponsor - $ 150.00

Emergency Contact (if under 18)

If you were born after 07/30/2003 you must fill out the Emergency contact information below. You can not pick up your badge without this information being filled out. This person is the one we would contact if you were unable to communicate for yourself in case of accident or serious illness.

Contact's Full Name *

Relationship to Attendee *

Phone Number *

Must be the main contact number. For Children 12 and under list the number of the parent.

Person Three - Person Three

Last Name *

First Name *

Middle initial *

Badge name *

24 characters including spaces. No 18+ words or references. If we have to change your name we WILL get creative!

Email address *

Email

Confirm Email

Physical Address *

Address Line 1

City

State

"Snail Mail"

Birthdate *

All attendees under the age of 13 must have a registered Adult 18 and over with them at all times.

Age on 7/22/2022 *

6-12 years old. Birthday between 7/22/2016 and 7/21/2010
13 to 17 Years old. Birthday between 7/22/2010 and7/21/2005
18 Years and older. Birthday on or after 7/22/20015

Age will be cross referenced with birthdate.

Registration level *

Teen/Adult - $ 55.00
Sponsor - $ 150.00

Registration level *

Child - $ 15.00
Sponsor - $ 150.00

Emergency Contact (if under 18)

If you were born after 07/30/2003 you must fill out the Emergency contact information below. You can not pick up your badge without this information being filled out. This person is the one we would contact if you were unable to communicate for yourself in case of accident or serious illness.

Contact's Full Name *

Relationship to Attendee *

Phone Number *

Must be the main contact number. For Children 12 and under list the number of the parent.

Total Amount

$ 0.00

Receipt information

Keep the confirmation email sent to you by Pay Pal. That is your confirmation of payment. We will ask you for proof of payment in case it is necessary.

The Fine Print.

By purchasing this registration you are agreeing to follow all AnimeIowa and Mindbridge policies. At any time should you be in violation of the listed policies, you may be asked to surrender your badge and/or leave the premises for the duration of the weekend. Check the website for the complete Rules, guidelines and policies at www.animeiowa.com

Comment or Message

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