Dismissed Watch Request Form
Thank you for your interest in Dismissed, a documentary amplifying the voices of women with bleeding disorders who’ve been overlooked for far too long. If you’re requesting to host a screening, please complete the form below so we can support your event and provide the necessary materials. If you’d like to just watch the film outside of a screening, please provide your name email and we’ll follow up with access to the film.
Organization Name
Primary Contact Name
*
First Name
Last Name
Primary Contact Email
*
example@example.com
Potential Date of Screening
-
Month
-
Day
Year
Date
Type of Screening
In-Person
Hybrid
Virtual
Estimated Number of Attendees
Who is your intended audience?
Teens
Adults
Caregivers
Healthcare Providers
Chapter Staff/Volunteers
Other
Additional Notes/Messages (Let us know if you have special needs, questions, or ideas!)
Submit
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