Public Relations

Request to Film on Campus at MD Anderson

Please review MD Anderson's ADM0415: Filming on Campus Policy prior to submitting your request and note that:

All requests to film on campus must be submitted to the Public Relations Office and will be reviewed and considered on a case-by-case basis.
We require at least two weeks to review and vet requests prior to scheduling any filming.
If approved, the entity will be required to:
- Share the final video with MD Anderson for review and approval prior to release;
- Sign MD Anderson’s Film Authorization Agreement; and
- Provide proof of liability insurance coverage in the amount of $1 million for property damage and $2 million for injury or death.

Requestor's Information

*Name:

*Phone Number:

*Email Address:

*Are you an MD Anderson employee?: Yes No

If Requestor is not an MD Anderson Employee

Organization:

Relationship to MD Anderson:

Name of your MD Anderson contact:

Project Details

*Film date(s):

*Film time(s):

*Specific location(s) to be filmed:

* Specific description of scene(s) you intend to film (interview, b-roll, clinic appointment, etc.):

*Person or people to be filmed:

*Are you asking to film any MD Anderson patients?: Yes No

*If approved, HIPPA Authorizations and media releases must be obtained prior to filming.

*Video Production Company Name:

*Does the video production company have liability insurance coverage in the amount of $1 million for property damage and $2 million for injury or death?: Yes No

*Number of people in video team for on-campus filming (include any producers, videographers, photographers, etc. who will be at MD Anderson):

Project Purpose

* Describe the final video you intend to produce using the scenes filmed at MD Anderson. Include any other interviews and scenes to be filmed outside of MD Anderson.

* How will the video be distributed?

* How will MD Anderson be described/portrayed in the video?

* How will the video benefit MD Anderson's mission?

If this request is related to an event or conference, please provide details. (Optional)

Is there anything else you want to share about your project to help us evaluate your request? (Optional)

Click on the “Submit” button below to email your completed request to Public Relations for review. Submitting this form is not a guarantee of approval for your request to film on campus.