Event Detail Form

Step 1 of 7 - Main Contact Details

14%

Unique ID

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Date of Issue

Name(Required)

First Middle Last

Your Contact Email(Required)

Are You Representing an Organization?

Name of Organization(Required)

Website

Title of Your Event(Required)

Have you set a date for your event?

Date of Your Event(Required)

What is the proposed date for your screening?

MM slash DD slash YYYY

Location of Your Event(Required)

Where will your proposed screening take place?

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Which License Are you Requesting?(Required)

Licenses are provided based on the number of expected viewers present at your screening event. Please choose the License that best suits your needs.

Please provide the circumstances for your Special Arrangement Request:(Required)

I would like to request a Pre-Recorded or Live Virtual Q&A with filmakers, Andrew Kaufman M.D. and/or Marcelina Cravat.(Required)

Pre-Recorded

Live

No Thanks

Proposed Date of Q&A(Required)

What is the proposed date for Q&A Session (if any)

MM slash DD slash YYYY

Host of Q&A(Required)

Who will be hosting Your Q&A Session?

Proposed Format of Your Q&A(Required)

Please provide a brief outline of the proposed format of your Q&A Session.

License Agreement(Required)

By purchasing this license, I agree to the following terms:

1. I will use this Screening License for a single screening only of TERRAIN: The Film, at the in-person event described and dated above.
2. I will not broadcast, reproduce, sell, or distribute, any files, video, communications, or contracts that are provided as part of this Screening License.
3. I will present the material in the spirit that it was created, that Terrain Theory is the correct scientific position for the advancement of knowledge and human health.
4. I will not use this screening opportunity to defame the filmmakers, the cast, or the material presented.
5. I am responsible for all aspects of creating, organizing, promoting, and managing my screening event.
6. I will have all technical aspects of my event and screening working correctly in the event that I am granted a Q&A session with Andrew Kaufman, M.D. and/or Marcelina Cravat.
7. I promise to conduct myself in truth and right action in all of my dealings with Andrew Kaufman, M.D. and his associates.

I agree to all of the above terms of license

Signature(Required)

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Licensee Name

This field is for validation purposes and should be left unchanged.

Event Detail Form

TERRAIN The Film

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