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    ImagiCon 2010 Guest Application Form

    This form is for professional actors, writers, directors, etc., who would like to apply for Guest status. Application does not guarantee or imply Guest status will be granted.

    This form is not for: bands, musicians, performers, or fans.

    Application Deadline: January 15, 2010, by 5 p.m. EST. Guests will not be accepted for ImagiCon 2010, after this date.
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    Legal Name (first, middle initial, last)
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    Professional Name (if different from above)
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    Address
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    City
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    State
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    Zip Code
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    Home Phone
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    Cell Phone
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    Work Phone
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    Email Address
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    Web site
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    Were you a Guest at ImagiCon2009?
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    Please provide a brief, 50 word bio written in the third-person. This will be used on the ImagiCon Web site.
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    Please provide a 250 word (or less) bio, written in the third-person. This will be used in the commemorative magazine.
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    If you would prefer ImagiCon to work directly with your agent, please check here.
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    Agent's Name
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    Agent's Company
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    Agent's Address
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    Agent's Phone
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    Agent's Email Address
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    Each Guest will be granted one additional membership beside their own. If more memberships are needed, they can be purchased at a reduced rate.
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    Please provide the first and last name of your guest.
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    What is your date/time of arrival and departure for the convention?
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    Table Requests

    If you choose not to be in the Walk of Fame, and would rather be in the Dealer's Room, you will receive a percentage off from the price of tables.
    The reduced rates for 10 x 8 area (which includes electricity and WiFi,) is $190.
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    10 x 8 Area
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    Your Requirements

    Please list your requirements necessary for participation, i.e. airline tickets, Per Diem, hotel room, other special accommodations.
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    Please enter Security Code

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    Department Director's Name
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