Bakuretsu Con Anime Music Video Form

First Name
Last Name
E-Mail*
Phone Number
Street Address
City
State
Zip Code
Video Information
Title of Video
CategoryRomance
Drama
Action
Comedy
Fun/Upbeat
Other
Song Title
Artist(s)
Video Source(s)
Name(s) to appear in Credits / Ballot
Date Video Completed
Video Upload *
Max Size: 1000mb