TRIUMPH Screening Request Form

Thank you for your interest in organizing a screening of Triumph: The Untold Story of Perry Wallace.

Please fill out and submit the form below, and be sure to include as many details as possible.

NOTE: There is no charge for public screenings. Use of the film requires official permission from Vanderbilt University, which will be provided if your request is approved. Screenings of Triumph may only be requested for not-for-profit, educational purposes. Events screening the film cannot charge for tickets and screenings cannot be affiliated with fundraising.

Questions? Contact us at triumphfilm@vanderbilt.edu.

ABOUT YOU AND YOUR ORGANIZATION
Name Name First Last
Email
Phone Phone - ### - ### ####
Organization Name
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Other groups that will participate or co-sponsor
Tell us more about your organization(s)
How did you hear about the film?
ABOUT YOUR EVENT
Proposed Screening Date (If the exact screening date is unknown, please list the approximate timeframe or indicate TBD.)
Event Purpose
Host Organization
Please list your host organization
Anticipated Audience Size
Event Program Description
VIPs, Special Guests or Speakers Invited
Speaker/VIP Role at Event
Venue (If unsure, please indicate TBD)
Will the screening be open to the public?

Will the screening be open to the public? Yes No
Do you plan to advertise the event? If so, how?
Anything else we should know about your screening?

TRIUMPH Screening Request Form

TRIUMPH Screening Request Form

ABOUT YOU AND YOUR ORGANIZATION

ABOUT YOUR EVENT