Screening Request Form

Contact Name *

First

Last

Email Address *

Phone # *

Organization, Title *

Please provide your organization name and your title

Address *

City/State/Zip *

Are you interested in filmmaker Karyl Evans participating in your screening event? *

Or are you interested in purchasing a Public Use License to screen the film without the filmmaker? *

When do you think you would like to screen the film? *

Please provide a date or an estimated timeframe

Where would you like to screen the film? *

Please provide a complete address

Does the location have video equipment or will you need to rent video equipment? *

Will you charge admission and if so do you know how much? *

Will the screening be part of a fundraiser or larger event/conference? *

Approximately how many people are you expecting to attend the screening? *

Please provide an estimated number

ASLA Chapters - are you interested in offering CEU credits for attending the event? *

Who will be signing the Letter of Agreement with title and their complete address? *

What is your approximate budget for this screening event? *

What is the address to send the Screener DVD to before the screening event? *

How did you hear about the film? *

Is there anything else you would like to add before submitting this request?

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