Name:
*
First Name
Last Name
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email:
*
Phone Number:
*
-
Theater Location (First Choice):
*
Basalt, CO - Movieland 7
Schenectady, NY - Movieland 6
Richmond, VA - Movieland at Boulevard Square
BTM - Isis Theatre
Theater Location (Second Choice):
*
Basalt, CO - Movieland 7
Schenectady, NY - Movieland 6
Ridgewood, NJ - Warner Theater
Richmond, VA - Movieland at Boulevard Square
BTM - Isis Theatre
BTM - Dutch Square Cinema 14
Preferred Movie (if available)
*
Type of Event:
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0/250
Date of Proposed Event:
*
-
Month
-
Day
Year
Alternate Date:
*
-
Month
-
Day
Year
Time of Proposed Event:
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1
2
3
4
5
6
7
8
9
10
11
12
:
00
10
20
30
40
50
AM
PM
AM/PM Option
Estimated # of Guests:
*
Event Details:
*
0/250
Please describe your event: ie is it a birthday party, a fundraiser, a community presentation, etc
*
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