Dear Mandela - Community Screening Survey * 1. Please tell us your name and where your Dear Mandela screening was held. Name: Company: City/Town: State/Province: ZIP/Postal Code: Country: Email Address: Phone Number: * 2. When did you hold your screening? Date * 3. How many people attended your Dear Mandela screening? * 4. How did the audience respond to the film? * 5. NEXT STEPS: Did audience members resolve to take any action beyond the screening? * 6. Any questions or comments for the Dear Mandela team? Done