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C2H2 Film Usage Survey
This survey is intended to help us understand the impact of films.  Contact information will only be used if we want to reach you with further questions.  No personal information will be shared.  
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Email *
What is the name of your organization (school/ hospital network, otherwise).  If viewing personally, you can just write "self". *
Date when you plan to show the film(s)? *
MM
/
DD
/
YYYY
Who is the intended audience for this film? *
Which best describes your location? *
Please provide information about where the film is being shown.  This can be City, State or zipcode.   *
Which films are you intending to show to your audience? *
Required
Do you intend to use the one-pager film guides? *
May we contact you with further questions about the films? *
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