Drive-In Movie Public Performance Licensing Request Form

Drive-In Movie Public Performance Licensing Request Form
Request permission to publicly exhibit a movie at your drive-in venue. Please provide complete details for licensing evaluation.
Organizer Full Name
First NameLast Name
Contact Email Address
example@example.com
Organization or Business Name
Venue Name and Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Event Date and Time
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Movie Title to be Screened
Estimated Audience Size
Screening Format / Technical Setup
Licensing/Distribution Details (if known)
Additional Information Relevant to Licensing Evaluation
Should be Empty: