The version of the browser you are using is no longer supported. Please upgrade to a supported browser.Dismiss

Gender Revolution Screening Request Form
Join the Gender Revolution! This is an opportunity for your school, club or non-profit to host a screening of GENDER REVOLUTION: A Journey With Katie Couric. By hosting an event, you are creating a safe space for anyone - straight, gay, cis, trans, male, female, bi - to ask questions. All must be welcome!

In this 90 minute documentary, Katie Couric sets out to explore the rapidly evolving complexities of gender identity. Learn more at www.NatGeoTV.com/GenderRevolution or email GR@picturemotion.com.

Your First Name
Your answer
Your Last Name
Your answer
Your Email Address
Your answer
Your Phone Number
Your answer
Name of your school, club or non-profit organization.
Screenings must be for groups of 30 or more. These DVDs are not for private use.
Your answer
How would you describe yourself?
What is the anticipated date of your event?
You don't have to be exact, but we do ask you send it to us once confirmed.
MM
/
DD
/
YYYY
What is the anticipated venue for your screening?
This could be your school name, the address of your nonprofits office, or the specific theater on campus. These cannot be in home screenings. However, if a home screening is your only option, please email GR@picturemotion.com for a special request.
Your answer
Please confirm that you agree to the following.
Every screening host must commit to the following criteria in order to receive their free DVD of GENDER REVOLUTION, host a screening, and receive a printed version of accompanying education guide, created by National Geographic and Journeys in Film
I agree that:
Required
Shipping Address
Once you fill out this form, and we review the information, we will ship your DVD and education guide to this address. PLEASE NOTE, WE CANNOT SHIP TO PO BOXES
Street Address (Include Apt#)
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
How did you hear about this screening tour?
Is there anything else you would like to share with us?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Picture Motion. Report Abuse - Terms of Service - Additional Terms