Blurriecon 2017 Artist / Vendor Registration Form

PLEASE NOTE: Artist and vendors must be at least 18 years of age on 10/13/2017!
All highlighted fields must be completed.
Please enter your full real name:
First: Last:
Preferred name or nickname (if any):
Store Name:
Email: Phone:
Provide your valid mailing address in the spaces below.
Address line 1:
Address line 2:
City: State: ZIP:
Provide 1 emergency contact below.
Name: Phone:
Space Requested:
Please describe your art or merchandise in the space below:

Please write any additional information or requirements (personal, store-related, or promotional) in the space below. Include addresses to online galleries, brick-and-mortar retail locations, and anything else we might consider for our dealer-room promotional information.

By clicking the button below and submitting this form, I confirm that I will be at least 18 years of age at 9:00 am on 10/13/2017. I also agree to comply with all of BlurrieCon 2017's standards and policies, and I understand that failure to do so may result in actions including revocation of my registration or removal from the convention venue without refund of admission.