Panel Submission This is the form to submit a proposal for a panel or workshop for presentation at Blerdcon 2019. Successful completion of this form does not guarantee that your idea will be selected. Once the submission period closes all entries will be put before a selection committee. The committee will choose which submissions will be accepted. Please complete all sections of the form to the best of your ability, and please refer to the panel and workshop F.A.Q. before emailing us with a question. The person submitting the form will be considered the lead panelist. Blerdcon cannot guarantee that your programming will not coincide with more popular events during any given time slot. While we will make every attempt to avoid conflicting with your convention schedule, by submitting this form you consent to allow your program to occur any time during convention hours. Panel times will allow for 5 minutes of setup time and 5 minutes of break down time. Should you run over your given time, panel programming staff will have the right to terminate your panel. This helps us ensure that we are fair to all programs taking place. Please only submit one panel or workshop per form. Submissions will close on Saturday, April 20, 2019. Step 1 of 5 20% Lead Panelist Name*By completing this application, you are automatically the lead panelist. Please use your real name for verification purposes. It must match the name on the ID that you will be showing at registration. First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Lead Panelist Email*Please provide and email that you check on a regular basis, as this will be our only method of communication prior to the convention. Enter Email Confirm Email Phone*Please provide a cell phone number, in case we need to reach you at during the conventionAre you above the age of 18?*This will not restrict you from being a panelistYesNoPlease enter your birthdate*The Lead Panelist for any panel needs to be at least 16 years old. Any Lead Panelist under 16 years old must have parent/guardian supervision. Any Lead Panelist running 18+ programming must be at least 18 years old.Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please provide the name of the supervising parent/guardian First Last Please provide the email address of the supervising parent/guardian Enter Email Confirm Email Additional Panelist Names and EmailsOnly you and up to 3 panelists will receive weekend badges. If you need more than 4 total panelists, they will need to purchase their own badge(s).NameEmail Title of Program You Wish to Present*This is the name of your panel or workshop. This will go on the website and in our program bookDescription of Program*Please be detailed in your description, but keep it down to 200 words max. This description will go on the website and in our program book. Please not we make every attempt to not schedule similar programming at the same time.Which category would your session best fit under?*AnimeVideo GamesCosplayMoviesComicsScience and TechnologyCulture and LifestyleKidsHow does your session address issues of diversity or inclusion in the geek space?*How do the members of your session or organization reflect or highlight underrepresented communities?*Do you (or your co-panelists) have a cosplay name/nickname that you would prefer to have listed on the website and in our program book?Registered NameNickname First Preferred Day and Time*Please note, we will do our best but days and times are not guaranteed.Select OneAnyFriday 1p, – 4pmFriday 4pm – 10pmFriday 10pm – 2amSaturday 10am – NoonSaturday Noon – 4pmSaturday 4pm – 10pmSaturday 10pm – 2amSunday 10am – NoonSunday Noon – 4pmSecond Preferred Day and Time*Please note, we will do our best but days and times are not guaranteed.Select OneAnyFriday 1pm – 4pmFriday 4pm – 10pmFriday 10pm – 2amSaturday 10am – NoonSaturday Noon – 4pmSaturday 4pm – 10pmSaturday 10pm – 2amSunday 10am – NoonSunday Noon – 4pmThird Preferred Day and Time*Please note, we will do our best but days and times are not guaranteed.Select OneAnyFriday 1pm – 4pmFriday 4pm – 10pmFriday 10pm – 2amSaturday 10am – NoonSaturday Noon – 4pmSaturday 4pm – 10pmSaturday 10pm – 2amSunday 10am – NoonSunday Noon – 4pmLength of Time Needed*Panel times are scheduled to allow 5 minutes of set up and break down time between sessions. Should you run over that time, programming staff has the right to terminate your session. Please note we will do our best to accommodate all requests, however, 50 minute long programs best fit our schedule.50 minutes80 minutesDo you require additional set up and breakdown time?*This adds 5 extra minutes of set up and 5 extra minutes of breakdown time without attendees in the room. Only select yes if you absolutely need the time to set up/break down. If we allot you the time and it is wasted that will affect your chances of presenting for Blerdcon in the future.YesNoIs your program 18+? (meaning for a crowd that is 18 and older only)?*Please be aware that 18+ programming will most likely be scheduled 10pm or later.YesNo Room Set Up*This determines what type of room we can best place you in based on your needs.Chairs (theater style)Tables (classroom/workshop style)Equipment and Hook Ups Needed* (Select all that apply)*Please note if an item is not listed here, we cannot provide it. Projector and Screen Sound VGA HDMI Display Port Adapter No equipment needed Are you a Blerdcon staff member or volunteer?*YesNoHave you done programming for Blerdcon before?**YesNoPlease list the program(s) you presented previously.*Will You Be Competing in the Cosplay Contest?*We can only accommodate competitors, not those wishing to merely attend these events. We apologize for the inconvenience.YesNoMay we take photographs of/film your program?*YesNoAny additional comments?PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.