Screening Request Form

Name

Organization

Email Address

Phone

Event Date

Time

Exact Location of Event:

Please note, the organization requesting the screening will be responsible for the shipping costs of the film.

Address Line 1

Address Line 2

City

Country

State

Provinces

State/Province

Postal Code

The event's intended audience is:

Please upload Event Flyer, Invitation, or Event Summary

I want to request an Art-Reach representative for Q & A at $500 honorarium fee.

Yes, We would like Art-Reach to attend our screening. No, Thank you

Additional comments or requests: