Viva la Verde screening request form

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Viva la Verde screening request form

Please fill out this form to request a screening event of Viva la Verde.

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* Required

Email *

Your email

Option 1

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Option 1

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Your Name *

Your answer

Your role or occupation *

Your answer

Phone number *

Your answer

Address (Street Number, Street name, City & Zip) where the film will be shown: *

Your answer

Venue name (if different than Organization Name)

Your answer

Venue Size (number of seats, if applicable)

Your answer

Audience Age range or grade(s)

Your answer

Audience size (estimate)

Your answer

What date & time would you prefer to host a screening?

MM

/

DD

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YYYY

Time

:

AM

PM

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