Screening Request - Advocacy Now

Now! Advocacy Saves Lives Community Partner Screenings

Thank you for your interest in holding a screening of Now! Advocacy Saves Lives. In order to obtain a copy of the film, we ask that you complete this simple form. We’ll reach out to you regarding your request. Thank you for helping us to educate and empower our community around the on-going impact of the HIV/AIDS epidemic.

Organization:*

(Note: If you are a chapter of a national organization, please include your chapter name)

Organization Website:*

(Note: If you are a chapter of a national organization, please list your chapter website)

Contact Person:*

First Name

Last Name

Home Phone:*

Work Phone:

Email Address:*

Please state the nature of the event in which the film will be screened:*

Please indicate location of the screening:*

Address Line 1

Address Line 2

City

State

ZIP Code

Please indicate date/time of the screening:*

By signing this agreement, you confirm that you are obtaining a copy of this film to use for complimentary community screenings and that neither you, your organization, nor any representative of your organization or its affiliates are requesting or receiving any type of financial payment or reimbursement for attending an event associated with the screening of this film. You further agree that neither you, nor any representative of your organization may make copies or replicate this film for any purpose, and under no circumstance sale the obtained copy of the film. You further agree that in all written and published materials (i.e. event invitations, programs, agendas, etc.), you must include an approved copy of the AIDS Healthcare Foundation logo (to be obtained by W.Imara Canady).*

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Print Name:*

First Name

Last Name

Title:*