Speaker Request Form
Please share as much information as possible to help us serve your needs
Email *
Name *
Organization Name
Organization Type *
Required
Phone number
City
State/Province
Zipcode *
Is this speaker invited via video or in-person? (choose the most likely scenario) *
Which film(s) would you like to screen (check all that apply) *
Required
Have you completed your purchase or booking of the film? *
Have you or your organization organized a successful film screening previously? *
Do you know which speaker(s) you would like to join you? (You may check multiple people)
Ideal Date for speaker to attend your screening (present - 2022) *
~if unsure, provide your best estimate~
MM
/
DD
/
YYYY
Any additional info about ideal date? (i.e. is your date firm or flexible?)
Estimated Audience Size
Clear selection
Are you working with any partner organizations you would like to mention? (please list names)
Anything else you want us to know about your screening plans?
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