First Name

Last Name

Company

Email

Home/Postal Address

Phone

Facebook

LinkedIn

Twitter

Instagram

Gender MFGender DiversePrefer Not to Say

Pronouns Him/HeShe/HerThem/They

NZ Citizen Yes No

If No, tell us your nationality

NZ Resident YesNo

Ethnic Group Māori Indigenous Pacific Islander Pākehā/Caucasian South Asian South East Asian North Asian Other Asian African Other/Mixed

Age Group 17-2425-4445-6465+

Work Details StudentSelf-EmployedWage/SalariedRetiredUnemployed

Screen Sector Work Yes No

If Yes, which sector - please tick Director Writer Producer DOP Editor Gaffer/Lighting Sound Other Technician Broadcaster Funding Agency Other Funder Sales Agent Distributor Exhibitor Academic Student Government(Local/National) Not For Profit Organisation/Company For Profit Organisation/Company

Year in Screen Industry 0-33-55-1010+

Experience in Documentary/Factual Sector BeginnerIntermediate 1-3 yearsMid-career 3-5 yearsExperienced 5+

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