Thank you for completing the form and submitting it by pressing the “Submit” button at the bottom of the page. NB: Please note that incomplete forms cannot be saved, nor considered. 1. YOUR DETAILS First name * Last name * Organisation * Country * - Select -AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R., ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan Province of ChinaTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Email * Telephone * Please include country code (eg. 0041 for Switzerland) 2. ABOUT THE FILM / CAMPAIGN Film or campaign title * Film description and content * Background information about the creation of the film / video campaign Please describe what lead to the creation of the film or video campaign... Film impact * Please describe here briefly how the submitted film has marked an impact. For instance; medias coverage, increase of donations, social medias buzz,.. 3. Credits Please include to whom the film or video campaign should be credited to: Credits for film * 4. Share your video Please either share the URL to your hosted video, or upload a low-resolution version (max. file size 50MB) of your film/video campaign herewith in standard video file formats .mp4, .avi, .wmv or .mov URL link to video (eg YouTube, Vimeo, your website) Upload file (max 50MB) Please note that should your film/campaign be chosen, we will be in touch to obtain a high-resolution version in advance of the event. Please bear in mind the fact that all screens at the Congress are in 16:9 format and clips should be formatted to maximise this.Files must be less than 50 MB.Allowed file types: avi mov zip mpeg4 mp4 h264. 5. Knowledge transfer Thank you for confirming the following by selecting 'I agree' in the box below: If selected for the 2022 World Cancer Congress as part of the Cinema, I give UICC the rights to broadcast this film/video campaign as part of the Congress, using the related credits. If music,or additional film material used in your film is not original, then permission from source must be obtained. The responsibility for this rests entirely with the filmmaker. Failure to obtain clearance could result in your film being withdrawn from the Programme. I agree that the film or video campaign (or a link to where it can be seen) may be made available for public viewing, using the related credits, on a dedicated 'WCC Cinema' page on worldcancercongress.org after the 2022 World Cancer Congress for a period of up to 12 months. I agree to the use of my personal data for the purposes listed above and I also agree to the UICC Privacy policy. Do you agree to the terms listed above * YES, I AGREE