VIZ Media . manga/anime club

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Welcome Manga/Anime club members!

Please fill in the following form so that we can contact your club
with the latest SHONEN JUMP, Shojo Beat and VIZ Media information.

Club Contact (Name):

Date of Birth:



(Must be 13 and over.)

Association Name (School, Library, etc.):

Address Line 1:

Address Line 2:

City:

State:

ZIP:

E-mail:

Phone:

What is the name of your club? (If no club name, please enter the school or library you are associated with)

Does your club have a website?

		Yes (If yes please enter URL)

		No

How often do you meet?

		Weekly

		Monthly

		Every few months

		Other

How many members do you have? (Please select one)

What is the age range of your club? (Please select one)

Your club is...(Please select only one)

		Mostly male

		Mostly female

		Half and half

What are the most popular types of anime or manga enjoyed by your club members? (Please check all that apply)

		Drama

		Mecha (Giant Robot)

		Shonen (Boys)

		Shojo (Girls)

		Sci-Fi

		Horror

		Comedy

		Fantasy

		Other, please specify

As a club, which do you enjoy more? (Please check one)

		Watching and discussing anime together

		Reading and discussing manga together

		Enjoy both equally

Where do the members of your club usually buy our anime, manga and other related goods from: (Please check all that apply)

		Anime convention

		Anime company online stores (like VIZ)

		Retail bookstores

		Local comic/hobby stores

		Auction sites (eBay)

		Online retailers (Rightstuf, Amazon)

		Mass merchandisers (Target or Wal-mart)

		Electronics stores (Best Buy)

		Other, please specify

Which of the following types of activities does your club participate in? (Please check all that apply)

		Anime conventions

		Card game tournaments/conventions

		Comic conventions

		Cosplay

		Group trips to enjoy Japanese foods

		Group trips to buy mass amounts of anime and manga related material

		Japanese cultural events

		Video game tournaments/events

		Other, please specify

Do your members regularly buy or subscribe to any of the following magazines: (Please check all that apply)

		Anime Insider

		DC Comics

		Game Informer

		Game Pro

		Giant Robot

		Marvel Comics

		OtakuUSA

		Play

		SHONEN JUMP

		Shojo Beat

		Pop J Neo

		Other, please specify

What site(s) does your club go to to get the latest anime and manga news? (Please check all that apply)

		ADV

		Tokyopop

		LiveJournal communities

		VIZ Media

		FUNimation

		Anime News Network (ANN)

		Slashdot

		Wikipedia

		Bandai Entertainment

		Cartoon Network

		iCV2

		Yahoo!

		Adult Swim

		Google

		Advanced Media Network

		IGN

		Other, please specify

The anime and manga selection in your local area... (Please check one)

		Meets the club's needs

		Does not meet the club's needs

What kind of anime/manga or Japanese pop culture merchandise would your club like to see available to the US market, that you are not finding now? (Please list up to 5 items; not character specific)

Which of the following activities/hobbies are your club members interested in? (Please check all that apply.)

		Drawing

		Resin model kits

		Video games

		DIY, craft-making

		Collectible card games

		Amateur animation

		Original comics

		Enjoy Japanese music

		Cooking Japanese cuisine

		Managing forums/online communities

		Learning/speaking Japanese

		Other, please specify

What would your group want from the VIZ Media Manga/Anime Club? (Please check all that apply)

		Email offers (e.g. discounts at our VIZ online store)

		Quarterly mailings of manga/anime goodies

		Other, please specify

If you/your club are interested in receiving the latest information in the following ways, please let us know! You may already be on some of these lists, but we just want to give you the chance to opt-in again!

		Yes, sign my club up in the VIZ Media Manga/Anime Club Program.

		Yes, sign me up for the SHONEN JUMP* Email Newsletter.*

		Yes, sign me up for the Shojo Beat* Email Newsletter.*

		Yes, send me via EMAIL information, advertising, offers and promotions related to VIZ Media, and/or their business partners.

		Yes, send me via POSTAL MAIL information, advertising, offers and promotions related to VIZ Media, and/or their business partners.

If you selected any of the above, please type in your club email address(es).

President's Name:				Birth Date (mm/dd/yy)

President's Email:

Additional Email:				Birth Date (mm/dd/yy)