NATO-MPAA Take Action Reward Program Application

Police or Incident Report (PDF Upload)
Applicant's Information
Applicant's Name
First Last
Applicant's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Applicant's Phone
Theater Information
Theater Name
Theater's Address
Street Address Address Line 2 City State ZIP Code
Theater's Phone
Theater Manager's Name
First Last
Theater Manager's Email*
Does your theater openly display in public view Anti-Piracy signage?
- Yes
- No

The incident
You have identified a person operating a recording device in order to copy a movie in a theater.
Date of occurrence?
Approximate time of occurrence?

: HH

MM
What Movie Title was being recorded?
Auditorium / Screen Number
Start Time of Movie

Police
You notified the police immediately?
- Yes
- No
If NO: Provide Comment
Date Police Notified
Time Police Notified

: HH

MM
What law enforcement agency did you call?
Law enforcement agency phone?
What is the Incident Report or Case Number?
Did you attach a copy of the Police or Incident indicated at the beginning of this application?
- Yes
- No
What officer(s) were assigned to this incident (names)?

The Suspect
Number of Suspects*
Suspect's Name
First Last
Suspect's Address
Street Address City State / Province / Region ZIP / Postal Code Country
Suspect's approx. age?
Suspect's physical description
Second Suspect's Name
First Last
Second Suspect's Address
Street Address City State / Province / Region ZIP / Postal Code Country
Second Suspect's approx. age?
Second Suspect's physical description
Third Suspect's Name
First Last
Third Suspect's Address
Street Address City State / Province / Region ZIP / Postal Code Country
Third Suspect's approx. age?
Third Suspect's physical description

MPAA Hotline
When did you contact the MPAA hotline (1-800-371-9884)
- At the time of incident
- Within 24 hours.
What day did you call?
What time did you call?

: HH

MM
Who answered your call?
First Last

Application
You have submitted this application to your Theater Manager for review
- Yes
You have met ALL qualifications.
- Yes
The grant of any prize, award, reward or other incentive issued by the MPAA, NATO and/or the Take Action! Camcorder Reward Program, including the amount or form of such prize, award, reward, or other incentive, is made at the sole discretion of the MPAA and NATO. Please allow 4-6 weeks for processing of this application.

Private: NATO-MPAA Take Action Reward Program