"Pitch Readiness Program for Multi-Episode Productions Application Form" - Manitoba, Canada

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Pitch Readiness Program For Multi-Episode Productions Application Form
Suite 410 - 93 Lombard Avenue
Winnipeg, Manitoba CANADA
R3B 3B1
Phone
(204) 947-2040
Fax
(204) 956-5261
Email
info@mbfilmmusic.ca
Website
http://www.mbfilmmusic.ca
Pitch Readiness Program For Multi-Episode Productions Application Form
PROJECT INFORMATION
Title of Project
Log Line (1-2 sentence project description)
Name of Production Company:
Company is self declared as:
Francophone
Aboriginal
Address
City
Province/State
Postal Code
Country
Phone
Email
Producer
Other Contact Person
Fax
Is project based on another
Yes
No
work If Yes
Title
Name of Author
Original Medium
Current Copyright Owner
What is the intended deliverables for this pre-market development stage (treatment, bible,
demo, proof of concepts, etc.?)
© 2016 MANITOBA FILM & MUSIC / MUSIQUE ET FILM MANITOBA. | 410-93 Lombard Avenue
Page 1 of 7
Winnipeg Manitoba Canada R3B 3B1 | TEL. 204.947.2040
Pitch Readiness Program For Multi-Episode Productions Application Form
Suite 410 - 93 Lombard Avenue
Winnipeg, Manitoba CANADA
R3B 3B1
Phone
(204) 947-2040
Fax
(204) 956-5261
Email
info@mbfilmmusic.ca
Website
http://www.mbfilmmusic.ca
Pitch Readiness Program For Multi-Episode Productions Application Form
PROJECT INFORMATION
Title of Project
Log Line (1-2 sentence project description)
Name of Production Company:
Company is self declared as:
Francophone
Aboriginal
Address
City
Province/State
Postal Code
Country
Phone
Email
Producer
Other Contact Person
Fax
Is project based on another
Yes
No
work If Yes
Title
Name of Author
Original Medium
Current Copyright Owner
What is the intended deliverables for this pre-market development stage (treatment, bible,
demo, proof of concepts, etc.?)
© 2016 MANITOBA FILM & MUSIC / MUSIQUE ET FILM MANITOBA. | 410-93 Lombard Avenue
Page 1 of 7
Winnipeg Manitoba Canada R3B 3B1 | TEL. 204.947.2040
Pitch Readiness Program For Multi-Episode Productions Application Form
COMMUNICATION AUTHORIZATION FORM
Name of Project:
(the “Project)
Program (TV/Web Development, Feature Development, TV/Web Production, Emerging Talent, Microbudget Production,
Manitoba Tax Credit, Feature Marketing):
By Signing below, the Applicant(s)/Borrower(s) hereby authorizes Manitoba Film & Music (“MFM”) to collect, use, disclose,
communicate and share information with the individuals listed in the table below (the “Authorized Individuals”) and with
any other person with whom MFM must reasonably communicate, on behalf of the Applicant(s)/Borrower(s), regarding all
aspects of this application (the “Application”), both before and after MFM goes to contract on the Project, as applicable.
Such collection, use, disclosure, communication and sharing of information includes information regarding the Application,
the contract, deliverables for drawdowns, personal information about production staff, artists, and other personnel
including work experience, residency, and ethnicity (the latter only for purposes of bonus points regarding Aboriginal
production for Equity Applications), as applicable, and potential amendments to any agreement signed, if applicable, as
well as any other issue surrounding the Project.
APPLICANT(S)/BORROWER(S) INFORMATION
Full Name
Telephone #
Mailing Address
Email Address
(If different from Applicant(s)/
Borrowers(s) address)
By Signing below, the Applicant(s)/Borrower(s) confirms that, unless MFM receives written notification and acknowledges
such notification, stating that an individual listed as an Authorized Individual is no longer permitted to liaise about the Project
on behalf of the Applicant(s)/Borrower(s), it is understood that the Authorized Individuals are authorized, at all times, to
communicate with MFM regarding the Project.
By signing this form, the undersigned Applicant(s)/Borrower(s), represents and warrants that he/she/it has the authority to
allow the Authorized Individuals to collect, use, disclose, communicate and share information regarding the Project.
If an organization:
NAME OF APPLICANT/BORROWER
By: ________________________________________
Title: ________________________________________
If an individual:
Witness
Signature of Applicant(s)/Borrower(s)
Print Name of Witness
Print Name of Application(s)/Borrower(s)
© 2016 MANITOBA FILM & MUSIC / MUSIQUE ET FILM MANITOBA. | 410-93 Lombard Avenue
Page 2 of 7
Winnipeg Manitoba Canada R3B 3B1 | TEL. 204.947.2040
Pitch Readiness Program For Multi-Episode Productions Application Form
INTENDED PROJECT FORMAT
Television or Web-based
Television
Web-based
Original Version
English
French
Other (specify)
Genre
Drama
Variety
Documentary
Children
Television Format
Series
Mini-series
Web-Based Format
Series
Mini-series
Technique
Live Action
Animation
Length Per Episode (minutes)
Number of Episodes
KEY CREATIVE
Province/State AND Country
Manitoba Producer
Biography of Individual
Co-Producer
Biography of Individual
Co-Producer
Biography of Individual
Script Writer
Biography of Individual
Show Runner
Biography of Individual
Other
Biography of Individual
© 2016 MANITOBA FILM & MUSIC / MUSIQUE ET FILM MANITOBA. | 410-93 Lombard Avenue
Page 3 of 7
Winnipeg Manitoba Canada R3B 3B1 | TEL. 204.947.2040
Pitch Readiness Program For Multi-Episode Productions Application Form
GENERAL INFORMATION ON THE PRODUCTION COMPANY
Production Company Profile (demonstrates sufficient experience & calibre of productions. Include
any previous awards and nominations)
Other Projects that have received funding from MFM Since April 1st
Production Company Bank
Bank Name
Address
City/Province
Postal Code
Phone
Fax
Production Bank Account Number
© 2016 MANITOBA FILM & MUSIC / MUSIQUE ET FILM MANITOBA. | 410-93 Lombard Avenue
Page 4 of 7
Winnipeg Manitoba Canada R3B 3B1 | TEL. 204.947.2040
Pitch Readiness Program For Multi-Episode Productions Application Form
FINANCING STRUCTURE FOR PRE-MARKET DEVELOPMENT
Public Funder
MANITOBA FILM & MUSIC
Public Funder
Production Company
Canadian Broadcaster
Specialty Services
Pay Television
Other (Specify)
Other (Specify)
Total Budget for pre-market development
Manitoba Expenditure
BREAKDOWN OF MANITOBA PRE-MARKET DEVELOPMENT EXPENDITURES
MANITOBA LABOUR & SUPPLIES/MATERIALS
SECTION “A” Development
LABOUR
SUPPLIES & ALL OTHER
TOTALS
COSTS
Manitoba Expenditures:
Rural
Urban
Total Manitoba Expenditures
Non-Manitoban
Expenditures
TOTAL “A” Development
Note: Total Expenditure must correspond to Total Development Budget
© 2016 MANITOBA FILM & MUSIC / MUSIQUE ET FILM MANITOBA. | 410-93 Lombard Avenue
Page 5 of 7
Winnipeg Manitoba Canada R3B 3B1 | TEL. 204.947.2040
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