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CONFERENCE APPLICATION

Application for Fusion: Access LA
Friday March 12, 2010
NBCUniversal campus

Applications are required for participation in the Fusion: Access LA day at NBCUniveral campus. The deadline for submissions is Friday, March 4, 2010. Please fill out the information below and email to fusion@outfest.org with Fusion: Access LA in the subject line. The 30 participants selected will be notified by Friday, March 5, 2010.

Name:
Email:
Phone:
Address:
City:
State:
Zip:
	If you are a filmmaker please list your production history:
	Has your work ever showed at Outfest or Fusion? If so, what is the title of the film that was shown?
	Please write a short statement (1-2 sentences) about what you hope to achieve by participating in Fusion: Access LA.
	You can also print this form and fax it to 213-480-7099, or send it to: Outfest c/o Kerri Stoughton-Jackson 3470 Wilshire Blvd., Suite 1022 Los Angeles, CA 90010