Kind Hearted Woman Screener Request Form

Kind Hearted Woman - Screener
You can pre-order a shortened version of Kind Hearted Woman for your community engagement events and screenings. You will receive 3 copies of screeners, one for your event and two additional copies to prepare your panelists, speakers or organizations in advance of the screening.

Please allow 2 weeks to receive your screeners.

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The following questionnaire must be completed in full in order to receive your screening resources.

Q.1
Organization or Station Name *

Q.2
Contact Name *


Q.3
Title *

Q.4
Mailing Address *





Q.5
Phone Number *

Q.6
Email Address *

Kind Hearted Woman: Community Engagement

Q.7
Proposed Event Date *





Q.8
Event Address *




Q.9
List proposed community partners/organizations supporting the event: *

(i.e. domestic violence and/or child abuse agencies, Native American organizations, RAINN, etc)

Q.10
Tell us about your event, what is your goal? *

Q.11
How do you plan to connect this event to the Women and Girls Lead Campaign? *

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