Screening License Agreement - The Rape of Recy Taylor

Thank you again for your interest in screening THE RAPE OF RECY TAYLOR. Please fill out the form below and click the “Submit” button to generate a screening license contract which will be presented to you onscreen as well as emailed to you as a PDF. Once this is complete, you will see a link to the final step to pay the license screening fee.
Name of Licensee*
First Last
Organization Name*
Email*
Address of Licensee*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Today's Date*
Date Format: MM slash DD slash YYYY
Date of Confirmed Screening*
Date Format: MM slash DD slash YYYY
Second Confirmed Screening Date
Date Format: MM slash DD slash YYYY
Price of Confirmed Screening*
Electronic Signature of Licensee*