Primary Contact Full Name:

Primary Contact Email:

Primary Contact Phone Number:

Entry Classification: Apprentice (under 13 years of age) Artisan (13 years and above) Exhibition (display only; not entered for award judging)

Name of Entry:

Complete name(s) of entrant(s):

Check here if your entry has masks or otherwise limits vision

Check here if your entry includes oversize/tall elements or limits mobility

If you have other special needs, please describe them here (remember: surprise the audience, NOT the masquerade staff):

Check here if you wish to forgo a tech rehearsal, and simply do a walk-on

Check here if you will be providing an audio file to accompany your presentation

If you declined the opportunity for a tech rehearsal, or you are not providing your own audio file for your entry, and you would like us to provide you with one of our pre-selected background music tracks, select your desired music style: Ambient - outer space-y Ambient - fantasy Ballad - romantic Ballad - tragic Ethnic - Celtic Ethnic - Middle Eastern/bellydance Ethnic - tribal Hard rock/metal/thrash Humorous/mischievous Jazz/swing/boogie woogie Mechanical/Steampunk Ominous/mysterious Orchestral - chase/frenetic Orchestral - heroic/adventure Orchestral - romantic Orchestral - scary/horror Upbeat pop music

Emcee Script (optional; note that if you forgo a tech rehearsal, the emcee can only read your script in ADVANCE of your entrance):

Check here if do NOT want the emcee to read your entry name before your entrance

Anything else you want to tell us or ask us? Type it here:

IMPORTANT: You must read the following waivers and check the boxes below to indicate your acceptance of the masquerade/cosplay terms. Failure to accept the terms and mark the checkboxes will disallow your participation in this year's event.

I have read the rules and procedures page for the DemiCon Masquerade/Cosplay, and agree to abide by them.

I understand that participants in the DemiCon 25 Masquerade/Cosplay will be photographed and filmed. I agree to hereby waive all rights associated with the publication and distribution of such photos and videos, and grant the Des Moines Science Fiction Society and/or DemiCon permission to use my Masquerade/Cosply likeness for editorial and promotional purposes. I further agree to hold harmless DemiCon 25 and the Des Moines Science Fiction Society LTD in all aspects relating to my participation.

Date: