16mm application form

To apply to borrow 16mm titles from ACMI Collections, 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 ACMI Collections on (03) 8663 2248 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
membership number
telephone
alternative telephone
mobile
facsimile
email address	(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 borrowing 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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