Independent Film Screening Release Form

I, the undersigned, hereby grant permission for the film entitled:

Film Title

to be exhibited at the event known as:

Event Name

on the date(s) of:

Date(s)

Screening Rights

I certify that I am the rightful owner and/or have secured all necessary rights to authorize the public exhibition of the above-titled film. I hereby release the organizers of the event from any claims related to copyright, trademark, or use of the film in connection with the screening event.

Contact Information

Name Email Phone Number

Signature