Protocol & Events - Filming Intake Form

Your Information

Contact Name*

Organization*

Email*

Telephone Number*

Project Information

Name of Project*

Name of Production Company/Producer*

Proposed Filming Location*

Proposed Date*

Proposed Start Time*

Proposed End Time*

Detailed Description of Production*

Include reason you'd like this project to be filmed at OHSU.

Number of Production Crew Members*

Additional Services

Please list any additional services that you are requesting (parking permits, catering, etc.)

Billing Information

Billing information is required to move forward with the booking of your event. *Please note, that your event is not confirmed until an event agreement has been signed by both parties.

Internal OHSU Billing Information

Fiscal Authority

FAID

Alias

External Billing Information

Billing Name

Billing Email

Company Name

Billing Address 1

Billing Address 2

Billing State

Billing City

Billing Zip

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