Yama-Con 2019 Panel Application
Please fill out the following form, answering all questions to the best of your ability. Remember, application submission does not guarantee that your panel will be accepted for Yama-Con programming. Failure to complete the form properly may result in your application being rejected. All applicants will be informed if their panel has been selected after panel submissions close.

All panel submissions must be received by 11:59 PM Sunday, October 13th, 2019.

Email address *
Panelist Information
Only one application is needed per panel. Panels with multiple hosts only need to submit one application. Select one host to be the point of contact person for your panel.
Name *
First and Last name. (No nicknames)
Your answer
Phone Number *
A number where you can be reached during the convention
Your answer
City, State *
Your answer
Date of Birth *
You must be 18 years of age or older by December 6th, 2019 in order to host an Adult Track Panel
Secondary Primary Panelist or Emergency Contact
We ask this information in the event we cannot reach you the Primary Panelist while at the convention.
Secondary Primary Panelist or Emergency Contact *
First and Last Name. (No nicknames)
Your answer
Relation to Primary Panelist *
Secondary Panelist or Emergency Contact Phone Number *
Your answer
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