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16mm Application Form

To access 16mm titles from the collection, please return this form and the Projector Service Report below completed by a qualified technician to:


ACMI Collections
PO Box 14
Flinders Lane
Melbourne, Victoria 8009

You can fill in this form online - type directly into each box, then print it out - or you can print it out and fill it in by hand. If you have any difficulty using this form, you can contact collections on (03) 8663 2467 between 9am and 5pm, Monday to Friday (AEST).

Note: The application should be completed by the person who will be responsible for screening our films.

ACMI respects your privacy.

Contact Details
Title
First Name
Last Name
Organisation
Department 
Access Card No.
Telephone
Alternative Telephone
Mobile
Facsimile
Email

 

(correspondence will be via email if you provide an address)

Details of Qualified Person
I am a qualified 35mm or 70mm projectionist. 
I am a qualified 16mm projectionist. 
What year were you qualified? 
Where were you qualified? 
I have other relevant experience or training. 
How often will you be booking 16mm films? 
When was the last time you operated a 16mm projector? 
How often do you clean your projector? 
How often is your projector serviced? 

Declaration
The information I have supplied is correct and I understand that I will be charged for any damage to films.
Date
 
Signature _________________________________


 

Projector Service Report

Contact Details
First Name _________________________________
Last Name _________________________________
Company _________________________________
Address _________________________________
  _________________________________
Suburb _________________________________
State _________________________________
Postcode __________
Telephone ________________________
Mobile ________________________
Facsimile ________________________

Service Details
Projector Model _________________________________
Date of Service ___________________
Tick each box to indicate completion
Equipment has been fully inspected for worn or damaged parts.
(please pay particular attention to film path, ie gate, sprockets, rollers)
Operation of equipment has been inspected (threading mechanism and take-up tension).
Equipment has been fully serviced.
Other - please provide details.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Declaration
I have completed the work specified and I am satisfied that this projector is in good working order.
Date ___________________
 
Signature _________________________________
 
 
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