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Short Film Screening P261012

Please provide us with your First and Last Name

*

Please provide us with your email address.

*

How old are you?

*

What, if any, religious or belief system do you practice?

*

A

Baptist

B

Evangelical

C

The Church of Jesus Christ of Latter-day Saints

D

Roman Catholicism

E

Judaism

F

Buddhism

G

Hinduism

H

Islam

I

Jehovah’s Witnesses

J

I do not consider myself to be part of any religion

K

Other

How would you describe your ethnicity?

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A

American Indian or Alaska Native

B

Asian

C

Black or African American

D

Hispanic or Latino

E

Native Hawaiian or Pacific Islander

F

White or Caucasian

G

Some other race

If selected, do you agree to arrive at the location at 6:45 to attend a short film viewing that will last 20 minutes on October 19th?

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A

Yes

B

No

Do you own a smartphone with internet access that you can bring to the film showing to complete the 10 minute feedback survey?

*

A

Yes

B

No