Thank you for attending a screening of Unrest! Please take a moment to answer a few questions about the film. Your feedback helps us measure and report the impact of our film and campaign.

First Name

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* 1. First Name

Last Name

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* 2. Last Name

Email

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* 3. Email

City

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* 4. City

State/Province

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* 5. State/Province

Country

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* 6. Country

Zip Code

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* 7. Zip Code

Are you

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* 8. Are you

How old are you?

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* 9. How old are you?

Do you consider yourself to have a disability?

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* 10. Do you consider yourself to have a disability?

What was the main motivation for you to attend the Unrest screening?

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* 11. What was the main motivation for you to attend the Unrest screening?

Overall, how would you rate your experience at this event?

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* 12. Overall, how would you rate your experience at this event?

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Rate your experience from Very Poor to Fantastic
Were you familiar with ME/CFS before this event?

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* 13. Were you familiar with ME/CFS before this event?

Did you learn new information about ME/CFS from watching this film?

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* 14. Did you learn new information about ME/CFS from watching this film?

Did you feel a strong emotional reaction to this film?

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* 15. Did you feel a strong emotional reaction to this film?

What is your opinion of the film? Please explain.

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* 16. What is your opinion of the film? Please explain.

In a few words, please describe your experience watching and discussing this film:

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* 17. In a few words, please describe your experience watching and discussing this film:

What type of action, if any, do you intend to take as a result of watching the film? (Check as many as apply)

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* 18. What type of action, if any, do you intend to take as a result of watching the film? (Check as many as apply)

Would you be interested in hosting a screening of the film at your University / School / Community Center / Church or other local venue. If Yes, please add your email address here:

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* 19. Would you be interested in hosting a screening of the film at your University / School / Community Center / Church or other local venue. If Yes, please add your email address here:

How did you hear about this event?

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* 20. How did you hear about this event?

Can we share quotes online or for our impact report?

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* 21. Can we share quotes online or for our impact report?

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