ACMI LOTE Screening Booking Form 2013

ACMI Screen Education can be contacted at screeneducation@acmi.net.au

School contact details

Enter the school contact details (* indicate required fields)

Name of school * Add school name Number and Street * Add number and street name Suburb * Add suburb name Postcode * Add postcode School Phone * Add contact number

Supervising teacher contact details

Enter teacher contact details

Teacher name * Add your name Teacher email * Add a valid email address Verify email * Retype email address Subscribe to ACMI Education e-News Mobile number * Valid mobile number

Select your program

Note: only one program and/or session may be selected below. To book an additional program and/or session, please return to this page and submit a new form.

• Astérix aux Jeux Olympiques Wednesday the 30th of Oct, Cinema 2
• Summer Wars Friday the 1st of Nov, Cinema 2
• The Girl Who Leapt Through Time Friday the 8th Nov, Cinema 2
• Krabat          Wednesday the 13 of Nov, Cinema 2
• Exploring French Animation Friday the 14th of June, Cinema 2
• Exploring French Animation Friday the 15th of Nov, Cinema 2

Number of students * Add number of students Year Level * Add number of students Please Select Prep Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10 Year 11 Year 12 Tertiary Number of staff * Add number of staff Special Needs Do Any of your students have special needs or acccess requirement?

Additional comments Insert your comments