Panelist Application

Name of Panel:
(50 char limit)
Panel Description

(As it will appear in con book):

Length of Panel:
Panelist Name:
Panelist Email Address:
Panelist Phone Number:
Panelist Mailing Address:
Co-Panelist Name(s)
Tech Needs
Prefered Schedule Time:Morning
Afternoon
Evening
Late Night
Prefered Day:Friday
Saturday
Sunday
Any questions or other comments:
Spam Control
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