2009-2010 Southern Circuit Call for Host Organizations

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2009-2010 Southern Circuit Call for Host Organizations
Information
Company Name:*
First Name:*
Last Name:*
Job Title:*
Address Line 1:*
Address Line 2:
City:*
County:*
State:*
ZIP/Postal Code:*
Business Phone:
Fax:
Website:
Email:*
Federal Employment Identification Number (FEIN):*
Congressional District:*
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Username:*
Password:*
Verify password:*
Security Question:*
Security Answer:*

Additional Information
Does your organization currently screen films?:	Yes No
Why does your organization wish to bring this program into your community?:
What impact will adding this program have on your organization's mission and/or program goals?:
How will your organization promote and cultivate the audience for this program in your community?:
Name of screening venue and address (if different from applicant organization):
Please describe the venue where you plan to hold the screenings - type of venue, seating capacity, projection equipment, etc.:
1st Preferred Day of the Week to Host the Tour.:*
2nd Preferred Day of the Week to Host the Tour.:*
3rd Preferred Day of the Week to Host the Tour:
Preferred screening times:
Scheduling conflicts for Sept-Nov 2010 and Feb-Apr 2011:

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