Special Use Screening Application

The application below is ONLY for events where it is not appropriate to request a free will offering, such as prisons and homeless shelters. If it is feasible to request a free will offering, please fill out the Standard Screening Application form, otherwise continue below.

Personal Information

First Name *

Last Name *

Email Address *

Phone Number

Screening Location *

Tell us about your event *

Date of Showing

Desired Date *

Address to ship Promotional Materials To:

Shipping First Name *

Shipping Last Name *

Shipping Organization *

Shipping Address *

Shipping City *

Shipping State *

Shipping Zip Code *

I agree NOT to post the movie online or use the film in any other way other than requested in this application. *

I agree NOT to use In His Image for any financial gain or charge viewers any fee (outside the free will offering to American Family Association.) *

By typing your signature, you confirm you are agreeing to the above terms and conditions.

Your Signature *

Sign Date *