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5th Avenue Cinema Space Use Request Form
Email address *
Organization Name (If not part of an organization put "N/A") *
Your answer
Index Code (If not part of an organization put "N/A") *
Your answer
Advisor Name (If not part of an organization put "N/A") *
Your answer
Primary Contact Name *
Your answer
Primary Contact Email *
Your answer
Primary Contact Phone Number *
Your answer
Name of the Event *
Your answer
Event Date *
MM
/
DD
/
YYYY
Start and End Times of Event *
Your answer
Description of Event *
Your answer
Expected Number of Attendance *
Your answer
Private Event or Open to the Public?
Popcorn (for a fee of $25 we will provide your guests with free popcorn) *
Would you like assistance in obtaining public screening rights to show a film? *
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