Applicant's Name (required) |
First Name: |
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Family Name: |
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Address (required) |
Street Address: |
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City: |
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State: |
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Zip Code: |
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E-mail address (required): |
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Confirmation E-mail address (required): |
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Type of Screening Party (required): |
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Category of Screening Attendees (required): |
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Type of DVD Preferred for Your Screening (required) |
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Date and Time of Screening (required)
*Please indicate the time if possible. |
Year: |
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Month: |
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Day: |
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Time: |
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From: |
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To: |
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Venue Name (required): |
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Venue Address (required) |
Street Address: |
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City: |
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State: |
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Zip Code: |
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Capacity of Venue (required): |
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Number of Attendees (required):
*If multiple screenings are scheduled on the same day, please enter the total number of attendees. |
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