Your Name:
Street Address (line 1):
Street Address (line 2):	Please DO NOT show city/state etc on this line - it's only needed if you have a two-line street address)
City:
Region/State:	(State, Province, etc. Please use standard abbreviations, like MI for Michigan.)
Zip or Postal Code:
Country:	United StatesCanadaUnited KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArubaAustraliaAustriaBahamasBahrainBangladeshBangladeshBarbadosBelgiumBelizeBeninBermudaBhutanBoliviaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBritish Windward IslandsBruneiBulgariaBurkina FasoBurmaBurundiByelorussiaCambodiaCameroonCanton And Enderbury IslandsCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandsCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCrotiaCubaCyprusCzechoslovakiaDemocratic Peop. Rep .Of KoreaDemocratic YemenDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEstoniaEthiopiaFalkland IslandsFaroe IslandsFederal Republic Of GermanyFederated States Of MicronesiaFijiFinlandFranceFrench GuianaFrench Indian Ocean AreasFrench PolynesiaFrench Southern And AntarcticGabonGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mcdonald IslandsHollandHondurasHong KongHungaryIcelandIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyIvory CoastJamaicaJapanJohnston AtollJordanKenyaKiribatiKuwaitLao People's Democratic Rep.LatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMexicoMidway IslandsMoldovaMonacoMongoliaMontseratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandPolandPortugalPuerto RicoQatarRepublic Of KoreaRomaniaRussiaRwandaSaint LuciaSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSoloman IslandsSomaliaSouth AfricaSpainSri LankaSt. Christopher And NevisSt. HelenaSt. Pierre And MiquelonSt.Vincent And The GrenadinesSudanSurinameSvalbard And Jan Mayan IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanThailandThe Czech RepublicThe GambiaTogoTokelauTongaTrinidadTunisiaTurkeyTurks And Caicos IslandTuvaluUgandaUkraineUnited Arab EmiratesUnited Republic Of TanzaniaUnited States Virgin IslandsUruguayVanuatuVatican City StateVenezuelaViet NamWake IslandWallis And Futuna IslandsWestern SaharaYemenZaireZambiaZimbabwe
Phone:
Email:
What games to you currently play:
How often will you demo games?
	2/Month Weekly More often
Are you interested in running demos at conventions?
	Yes No Maybe
Are you willing to travel to conventions to demo games?
	Yes No Maybe
How far are you willing to drive/travel to do game support?
	30 miles 60 miles 120 miles 300 miles More than 300 miles