The S Word Screening Request Form
Thank you for your interest in organizing a screening of The S Word. Please complete the form below and we will be in touch very soon.

NOTE: All public screenings **require** a license, the cost of which will be determined based on your responses. We are currently organizing screenings for the first quarter of 2018. If you have any questions or need immediate assistance, please email Patricia Harris DiLeva: madpixfilms@gmail.com 
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About You
First Name *
Last Name *
Email address *
Phone number
Organization / Affiliation / School Name *
How did you hear about the film? *
City *
State/Province *
Country
About Your Event
Desired Date of Screening *
Anticipated Audience Size *
Venue (If you aren't sure, simply type TBD) *
Are you charging for tickets? *
Is your event a fundraiser? *
Is the screening open to the public? *
Do you plan to advertise the event? If so, how? *
Are you interested in inviting director Lisa Klein to speak at your event? (Please note, travel, accommodations and a speaking fee are required. We will send you the details if you are interested.) *
Is there anything else you would like to tell us about your event?
Submit
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