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   Host a Screening Registration Form  
  Items in bold will appear on our Screening Map.
Items with an asterisk "*" are required.
* Name:  
* Phone:  
* E-mail:  
* Organization:  
* Screenings:  
* Contact:  
(if different from "Name" above)   
* Main Phone:  
* Cell/Alternate Phone:  
* Fax:  
* Screening Info E-mail:  
* Proposed Venue for   
Screening:
 

Venue Name:
Address:

City: State: Zip Code:
 

Promotional Materials   
You Would Like to Order:  

Included in screening fee:
(check box next to items you would like us to send you FREE OF CHARGE)

Two (2) 11 x 17 promotional posters
One (1) 24 x 36 full size movie poster

To order additional items fill out this form below:
    Quantity
12 x 18 posters
Price: $5.00 each additional
 
  24 x 36 one sheet/full movie posters
Price: $7.50
 
  Postcards
Price: $20.00 for 250
 
  Postcards
Price: $75.00 for 1000
 
 

Check this box to have the
producer attend the screening?
Price: $475.00 for one day plus expenses.

Host may make and book Producer's travel arrangements in consultation with Producer, or JAFAH will book travel arrangements, in consultation with Host, and invoice Host.  Also, if Producer's attendance is requested for more than one day, JAFAH will bill Host under separate invoice.

Thank you.
 

* Payment:
   PayPal Check
 
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Copyright 2006 Eliezer Films. All Rights Reserved
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