As film makers we are keen to keep track of how often the film is screened and how many people get to see it. We would appreciate it if you would take a few minutes to fill in this form to let us know about screenings that you hold. Please fill in a separate form for each screening or cinema run.

* 1. Type of screening:

* 2. Location:

* 3. Screening period:

Start date:

* 4. Screening period:

End date:

* 5. Estimated audience size:

* 6. Basis for estimate:

* 7. Purpose for screening: (please choose any relevant options)

* 8. If your screening was a fundraiser can you please let us know what you were fundraising for:

* 9. How much money were you successful in raising:

* 10. From time to time we like to share testimonials of people who have watched / hosted the film. If you would like to, can you please provide us with a quote that sums up your experience of watching and / or screening the film. (Please note we will be using these quotes in publicity materials and reports that we publish about the film.)

Thank you for taking the time to provide us with this data!