Screening Information
Please fill in your screening details below. We will contact you within 7 days to finalize your screening after receiving this request.
Sign in to Google to save your progress. Learn more
Your First Name *
Your Last Name *
Your Email Address *
Your Phone Number *
Please list as (xxx) xxx-xxxx
Your Organization's Name *
Which group will be the main organizer or sponsor of the screening? (Ex: "Penn State AMWA Chapter)
Your Title
Your Organization's Website
What is your organization's complete web address or Facebook page?
Co-Hosting Organizations
Which organization(s) might you collaborate with to co-sponsor a screening?
Your Shipping Address *
Please enter your complete address (Name of recipient, street address, city, state, and ZIP code). This is where your screening kit will be shipped, so please make sure this is the correct address for receiving shipment.
Venue Name *
Please list your venue's official name.
Venue Street Address *
Please indicate your venue's street name and number. (This will be the location where your audiences should arrive!)
Venue City *
Venue State *
Date of Exhibition *
Please list the date you wish to host your event (i.e. 5/16/18).
Time(s) of Exhibition *
Please list the time(s) you plan to hold your event (i.e. 7:30 pm). [Tip: States of Grace is 75 minutes in run time.]
Do you wish to host multiple events?
Please let us know if you wish to show the film more than once.
Public Listing? *
Will your screening be available for public audiences to attend? If so, we'd like to help promote your event on STATES OF GRACE's website!
Post-film discussion? *
We will be hosting a few virtual appearances by Grace and the filmmakers. If you wish to discuss the possibility, please indicate your interest here.
Applying for event funds? *
The purpose of this grant is to assist in supporting educational screenings of States of Grace at AMWA chapters and branches around the country. The monies can be used to coordinate receptions, publicity and other needs. An AMWA member must be one of the persons responsible for the event. Grant amounts: $100 for events with 1-49 attendees / $150 for events with 50-99 attendees / $200 for events with over 100 attendees. Please fill in the grant amount you are requesting and any other details. NOTE: Please indicate the name and address that you would like the check to be made out to/mailed to if different from above.
How many attendees are you expecting? *
Questions or Comments?
Anything you would like to add?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms