Screening Consent Form This states that FUNimation Entertainment consents and gives full permission to the screening of .hack//SIGN, .hack//Roots, .hack//Legend of the Twilight, .hack//G.U. Trilogy, .hack//Quantum, A Certain Magical Index, A Certain Magical Index II, A Certain Scientific Railgun, A Certain Scientific Railgun S, Aesthetica of a Rogue Hero, Afro Samurai, Afro Samurai: Resurrection, Ai Yori Aoshi, Air Gear, Akira, Appleseed XIII, Appleseed XIII Tartaros & Ouranos, Aquarion, Aquarion EVOL, Aria – The Scarlet Ammo, Armitage III, Athena, B Gata H Kei – Yamada’s First Time, Baccano!, Baka and Test, Baka and Test Summon the Beast, Baka and Test OVA, Baldr Force EXE, Basilisk, Mongolian Chop Squad, Ben-To, Birdy The Mighty: Decode, Black Cat, Black Lagoon, Black Lagoon: The Second Barrage, Black Lagoon: Roberta’s Blood Trail, Blade of Phantom Master, BlazBlue: Alter Memory, Blood C, Blood C: The Last Dark, Blue Gender, Brother’s Conflict, Bubblegum Crisis 2040, Buddy Complex (subtitled only), Bullet, Burst Angel, C-Control: The Money and Soul of Possibility, Case Closed: The Last Wizard of the Century, Case Closed: Captured in Her Eyes, Case Closed: Countdown to Heaven, Case Closed: The Phantom of Baker Street, Casshern Sins, Chaos;Head, Chobits, Chrome Shelled Regios, Code:Breaker, Comic Party Revolution,Confucius, Corpse Princess, Cowboy Bebop, Coyote Ragtime Show, D-Frag!, Daimidaler, Danganronpa: The Animation, Darker Than Black, Darker Than Black: Gemini of the Meteor, Desert Punk, Devil May Cry, Dragon Age: Dawn of the Seeker, Dragon Ball, Dragon Ball GT, Dragon Ball Z, Dragon Ball Z Kai, Dragonar Academy, Eden of the East, Eden of the East: Paradise Lost, Eden of the East: The King of Eden, Ergo Proxy, Eureka Seven, Eureka Seven: Astral Ocean, Evangelion 1.11, Evangelion 2.22, Excel Saga, Fairy Tail (Episode 1-175), FLCL, Free –Eternal Summer-, Freezing, Freezing: Vibration, Fruits Basket, The Future Diary, Ga Rei Zero, Gantz, Ghost Hunt, Girl$, Glass Fleet, Good Luck Girl, Guilty Crown, Gungrave, Haganai, Haganai: Next, Haibane Renmei, HAL, Heaven’s Lost Property, Heaven’s Lost Property: Forte, Heaven’s Lost Property: The Angeloid of Clockwork, Hellsing (TV), Hellsing Ultimate I – X, Hero Tales, Hetalia Axis Powers, Hetalia World Series, Hetalia the Beautiful World, Higanjima: Escape from Vampire Island, High School DxD, High School DxD New, Hyperdimension Neptunia, Ichi, Inari Kon Kon, Initial D, IP Man: The Legend Reborn, Is This a Zombie? Is This a Zombie Of the Dead?, Jormungand, Jormungand Perfect Order, Kamisama Kiss, Kamui, Karneval, Kenichi: The Mightiest Disciple Season 1, Kenichi: The Mightiest Disciple Season 2, Kiddy Grade, King of Thorn, Kurau Phantom Memory, Last Exile –FAM, The Silver Wing-, The Legend of Legendary Heroes, Let Me Out, Level E, Love Hina, Lupin the Third: The Woman Called Fujiko Mine, Maken-Ki!, Maken-Ki! Two, Mass Effect: Paragon Lost, Michiko & Hatchin, Moeyo Ken, MoonPhase, Mulan, Rise of a Warrior, Murder Princess, Mushishi (TV), Mushishi (Live Action), My Bride is a Mermaid, Negima, Noir, Noragami, Oblivion Island: Haruka and the Magic Mirror, Oh! Edo Rocket, Okamisan and Her Seven Companions, One Piece: Film Z, One Piece: Strong World, OniAi, Origin: Spirits of the Past, Panty & Stocking with Garterbelt, Peach Girl, Phantom: Requiem for the Phantom, Ping Pong: The Animation, Princess Jellyfish, Psycho-PASS, Psycho-PASS Season 2 (subtitled only), Puchim@s, Puchim@s 2, Red Data Girl, Riddle Story of Devil, Rideback, Rin ~Daughters of Mnemosyne~, Robotics;Notes, Rosario+Vampire, Rosario+Vampire CAPu2, Rumbling Hearts, Sukura Wars: The Movie, Samurai 7, Samurai Champloo, Sankerea: Undying Love, School Rumble, Sekirei, Selector Infected: Wixoss, Sengoku Basara Season 1 & 2, Senran Kagura: Ninja Flash, Serial Experiments Lain, Shakugan no Shana Season 1, Shakugan no Shana Season 2, Shakugan no Shana Season 3, Shakugan no Shana: The Movie, Shangri-La, Shigurui: Death Frenzy, Shiki, Shonen Hollywood, Slayers Revolution, Slayers Evolution, Smuggler, Solty Rei, Soul Eater, Soul Eater Not!, Space Battleship Yamato, Space Dandy, Spice and Wolf Season 1, Spice and Wolf Season 2, Steins;Gate, Strike Witches Season 1, Strike Witches Season 2, Summer Wars, Suzuka, Switch, Sword With No Name, T.O., Tales of Vesperia, Tenchi Muyo, Tenchi Universe, Tenchi OVA Collection, Tenchi in Tokyo, Terror of Resonance, TechNolyze, The Devil is a Part-Timer, The Woman Knight of Mirror Lake, Tokyo ESP, Tokyo Majin, Tokyo Ravens, Toriko, The Treasure Hunter, Trigun, Trigun: Badlands Rumble, Trinity Blood, Unbreakable Machine Doll, Utawarerumono, Vampire Girl vs Frankenstein Girl, Vexille, Wanna Be the Strongest in the World, We Without Wings, Welcome to the NHK, Wolf Children, xxxHolic, Yu Yu Hakusho, Zebraman 2, during your upcoming meeting(s), screening(s), event, or convention. 1200 Lakeside Parkway Building 1 • Flower Mound, TX 75028 • (972) 355-7300 Phone • (972) 355-1382 Fax Please note, however, that without further written or online permission, our consent is limited to screenings, which are a) on or before December 31, 2015 b) held at the screening site during regular screening hours c) open to all attendees without a convention badge, ticket, fee, or similar d) of official releases, FUNimation provided screeners, or streamed from FUNimation.com or it’s official partner sites – YouTube.com/FUNimation, Hulu, Crackle, Netflix, iTunes, Google Play, Xbox Video, and Sony Video. Also, you must adhere to the following conditions a) Screeners may not be copied. b) No video recording during the screening. c) Please make an announcement before the screening that recording is not allowed. d) Please ensure that there will be no recording (eg. monitors walking the aisles). All other rights are expressly reserved. Additionally, we understand that your organization may be planning to publicize or commemorate the upcoming event by taking photographs. We would very much like to use any such photographs for publicity or promotional services, and we believe that any publicity generated by such use would benefit FUNimation Entertainment and your organization. However, you are by no means obligated to provide photographs in order to get screening permission. If you choose to send photographs to us, you are granting FUNimation the right to use them as noted above. Please indicate your consent and the consent of your organization to the above terms by filling out this form. Representative Printed Name Victor Lotocki Representative Signature Organization Name: Club That Really Likes Anime FUNimation Entertainment 1200 Lakeside Parkway Building 1 Screening Location: 200 University Ave. West, Flower Mound, TX 75028 Waterloo, Ontario, Canada 1200 Lakeside Parkway Building 1 • Flower Mound, TX 75028 • (972) 355-7300 Phone • (972) 355-1382 Fax .