Name *

First Name

Last Name

Phone

Country

(###)

###

####

Ideal Screening Date

MM

DD

YYYY

Ideal Screening Time

Hour

Minute

Second

AM PM

Number of screenings *

1

2

3

Other

Would you like Director Lacey Schwartz or another member of the Little White Lie team to attend your screening event to present the film and engage your audience in a post-screening discussion? (r *

Due to heavy demands on her schedule, Lacey can only attend where an honorarium plus travel expenses can be offered.

Yes

No

Potentially depending on fee