Community Screening Request Form
Thank you for your interest in hosting a screening of THE QUIET EPIDEMIC! Please complete this request form with as much information as you currently have, and our Screenings team will respond within 3 business days regarding next steps.

Please note that all screenings of the film will require the purchase of a screening license. The cost of the license will be based on the answers provided in this request form, including but not limited to the type of host organization and/or the number of estimated attendees. All screening license funds are paid directly to the film team and will be used to continue the social impact campaign for the film.

You are welcome to charge for tickets to recoup license fee costs, for a fundraiser for an organization or individual of your choice, or to simply to turn a profit on your event.

Email screenings@thequietepidemic.com with any questions.
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First Name *
Last Name *
Email Address *
Phone Number *
Organization / Affiliation / School Name *
City *
State / Province *
Country *
Desired Screening Date (if known) *
If you aren't sure when you may want to host your screening, you can put a placeholder date here.
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Anticipated Audience Size *
Will your screening be in person or virtual? *
Venue if in-person screening (If you aren't sure, simply type TBD) *
Will your screening be open to the public? *
Do you plan for charge for tickets? *
You are welcome to charge for tickets to recoup license fee costs, for a fundraiser for an organization or individual of your choice, or to simply to turn a profit on your event.
Will you be using your screening event as a fundraiser / benefit? *
If you answered "Yes" to the previous question, what organization or cause will you be fundraising for with your event?
Do you plan to advertise the event? If so, how? *
Is there anything else you'd like to share with us about your potential screening event? *
How did you hear about the film? *
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This form was created inside of The Lyme Trials.