When you submit this form, I will contact you by email to set up your Film/Q&A session. I’m looking forward to meeting you!

Name

First Name

Last Name

Email

Please describe your group and how you intend to use the Film/Q&A Session.

Phone (only used if necessary to finalize last minute details)

(###)

###

####

Will you be hosting the Film/Q&A Session on your own Zoom account?

Yes, I will host the Zoom Film/Q&A Session.

No, I would like Laurie to host the Zoom Film/Q&A Session.

Will the group be physically together?

Yes, the group will be in a room together.

No, we will all be participating online.

When would you like to hold the Film/Q&A Session? List 3 options with date, time and time zone.

Organization Name (if applicable)

Group Size

10 or less

11-25

26-50

50+