Event Screening Sign-Up Form
Help us learn more about your event or request the filmmakers by filling out the following information. Filling out this form will increase the likelyhood of having your event featured on vaxxedthemovie.com

Please note that the filmmakers are currently participating in the Vaxxed Nation Tour and will be traveling across the country over the next few months with limited availability. To book the filmmakers along their route please use this form instead: https://goo.gl/forms/7hSOzbFWBj4G8ZyB2

Name
Your answer
Organization
Your answer
Organization Website URL (Required If Applicable)
Your answer
Email
Your answer
Date of Event
MM
/
DD
/
YYYY
Time of Event
Your answer
City of Event
Your answer
State/Province of Event
Your answer
Country of Event
Your answer
Have you already purchased your screening license?
Type of Event
Is this a free event or is there an admission fee?
How many people do you expect to attend your event?
Phone number
Your answer
Describe Your Event
Please be detailed but concise and limit your description to 200 words
Your answer
Is your event venue already confirmed/approved?
Are you wanting a Q&A with the filmmakers
Please note that the filmmakers are currently participating in the Vaxxed Nation Tour and will be traveling across the country over the next few months with limited availability. To book the filmmakers along their route please use this form instead: https://goo.gl/forms/7hSOzbFWBj4G8ZyB2
Required
Are you able to cover travel expenses
Would you be interested in a Q&A via Skype?
Comments and Additional Information
Your answer
Can I Change My Answers Later?
Yes, you will be able to update your answers after submitting.
Submit
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