BlurrieCon 2017 Panel / Programming Application Form

Please complete all highlighted fields below.
PLEASE NOTE: Panel presenters must be 18 or older except by written permission of the Panel Manager.
(Please Email for details.)
All presenters of panels restricted to ages 18+ must be 18 or older without exception!
Please enter your full real name:
First: Last:
Preferred name or nickname (if any):
Panel Title:
Other Contact:
Co-Panelists (List All):
(Other Contact may be Facebook, Twitter, etc. but must be in addition to a valid Email.)
This panel is suitable for the following audience:
About how long will your panel or program be?
What is your preferred day, if any?
What is your preferred timeslot, if any?
(Please note that panel slots are assigned by the Panel Manager, but we will do our best to accomodate requests.)
Please describe your planned panel or programming in the space below.
Please write a cool description for our convention booklet below.
Please describe any additional requirements, materials or costs.