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Multiple Choice - Screening Inquiry Form
Please complete the form with as much information as possible and our team will get back to you soon. This is not a commitment to host, simply a request for information. 

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First Name *
Last Name *
Organization / Institution Name *
Email address *
Phone number *
How would you categorize your organization or institution? *
What best describes your role? *
Please select one.
Your Title / Role 
Country *
City *
State (US only) *
Province or Territory (Canada only)
Proposed screening date *
Can be an estimation and subject to change
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Estimated audience size *
Tell us a bit more about why you're interested in the film or what you hope the film will do for you and your audience. *
Would you be interested in receiving information about long-term streaming access to the film? *
Anything else you would like us to know
How did you hear about Multiple Choice?
Tell us a bit more about why you're interested in the film or what you hope the film will do for you and your audience.
If you have in the past or are currently implementing innovation, please describe those initiatives (type, scope, group/individual leading, etc.).
Describe your desired/planned innovation initiatives that you'd like to implement after screening the film (type, scope, group/individual leading, etc.).
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