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Media Pass Application Form

Person #1  
Name: _____________________________________________________________
Address: _____________________________________________________________
  _____________________________________________________________
E-Mail: _____________________________________________________________
   
Person #2  
Name: _____________________________________________________________
Address: _____________________________________________________________
  _____________________________________________________________
E-Mail: _____________________________________________________________
     
Company/Publication Name: ________________________________________________
Mailing Address: ________________________________________________
  ________________________________________________
E-Mail: ________________________________________________
URL: ________________________________________________
Expected Day(s) of Attendance: ________________________________________________
     
Please include a brief description of your publication or web site including size, circulation, target audience, the amount and type of coverage you are interested in providing, and any other information that would be helpful in processing your application.
     
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________


Deadline for submission: postmarked by May 7, 2005.

Address to send completed application forms:

media@animenorth.com

or

Anime North 2005
762 Upper James
Suite 127
Hamilton, ON
L9C 3A2

Fax: 905-383-7770 Attn: Anime North Suite #127

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