Screening Request for "The Providers"
Thank you for your interest in sharing "The Providers" with your community. Please complete the following form and we will be in touch with you about accessing the film.
What is the name of your organization or institution? *
Your answer
Type of organization: *
Required
Is this request for a conference or symposium? *
Please describe your interest in screening the film (for example, to educate your medical students about rural healthcare): *
Your answer
Do you have a date when you would like to host a screening? (Leave blank if your date is TBD.)
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In what city would the screening take place? *
Your answer
In what state would the screening take place in? *
Your answer
Are you interested in bringing the filmmakers and/or film participants to your event? *
This is optional, and would require that travel, accommodations and a speaking fee be covered.
What is your name? *
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What is your job title? (Optional)
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What is your email address? *
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Anything else you would like to tell us? (Optional)
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