RE:MEMBER Screening Request Form

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Thank you for your interest in organizing a screening of RE:MEMBER. Please complete the form below to let us know about your screening. If it is a public screening we will publicize it on the screenings page of the RE:MEMBER website.

NOTE: All public screenings **require** a license, the cost of which is determined by the number of people you plan to screen it to (as shown on the Host a Screening page on the website). You may charge for your event at your discretion or use the screening as a fundraiser for a relevant cause. (https://www.rememberdoc.com/host-a-screening)

Your Name (first and last) *

Email address *

Screening date and time? TBD if you don't know yet. *

Screening location/address if you already know (so we can post it)? TBD if you don't know yet. *

Intended audience size? *

1-25

1-50

1-150

1-250

+250

Are you showing this in a theater? Will you need a DCP or a Blu Ray? *There will be additional fees for the delivery of either a DCP or a Blu Ray*

Yes

Maybe

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If you'd like to tell us more about your mission and or goals, please do so here.

Are you interested in having Victoria Markham come for your screening? *Additional fee will apply. If you check yes or maybe we will send you more information*

Yes

Maybe

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