Registration Form - Out of Faith - an eliezer films production

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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