FIRST NAME ______________________ LAST NAME________________________

PHONE ____________________________MOBILE:__________________________

EMAIL _____________________________ WEBSITE_________________________

ADDRESS ____________________________________________________________

_____________________________________________________________________

CITY ________________ STATE ___________ ZIP ________ COUNTRY________

I am submitting a: FEATURE____ NARRATIVE SHORT ____DOCUMENTARY______

PROJECT TITLE (English) _______________________________________________

ORIGINAL TITLE______________________________________________________

ORIGINAL LANGUAGE____________________SUBTITLES___________________

YEAR OF COMPLETION_________ RUNNING TIME ________________________

SCREENING FORMAT(S)________________________________________________

DIRECTOR __________________________ PRODUCER ______________________

This will be a World Premiere ___ US Premiere___ NYC Premiere___ at MIAAC 2009

I heard about the IAAC Film Festival through ____________________________

I have read the Submission Guidlines, and signed and submitted the Filmmaker Agreement.

Signed ________________________ Title__________________________

Date:_________________________________