* 1. Please tell us your name and where your Dear Mandela screening was held.

* 2. When did you hold your screening?

Date
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* 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?

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