We'd like to get to know you:

Email*
Name
Street address
City*
Province/State**
Country*
Postal Code/ZIP*
Home Phone
Work Phone
Company Name
Organization	Other * required ** required if in North America

I'd like to volunteer to spread the word about the film:

		by sending an email to my lists
		by putting up posters in my neighborhood
		by distributing leaflets & postcards
Other

		I'm part of an organization that would like to support your film launch.
		I'm part of a media organization that supports grassroots movements.
		I'm willing to receive emails about other films, events or campaigns with a similar focus to The Take.
		I would register to be part of an online activist network in the future.
Comments	I want to help - get in touch