Real Talk Booking Request Form

Real Talk Booking Request Form

To book a free Real Talk presentation, please complete the form below. We will connect with you as soon as possible and confirm a date based on the availability of our facilitator! All fields are required. Please note that the presentation includes a video, so A/V equipment must be available. This presentation is appropriate for a virtual audience size is 25 for a virtual event and/or an in person event with a minimum of 50 attendees . For any questions, please contact Atate@advancedrecoverysystems.com.
Name of School or University*
School/University Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Point of Contact (Full Name)*

First NameLast Name
Title*
Email*
example@example.com
Phone*

Area CodePhone Number
Presentation Date (Option 1)*

MonthDayYear
Date
Presentation Date (Option 2)*

MonthDayYear
Date
Presentation Date (Option 3)*

MonthDayYear
Date
Presentation Date and Time (Option 2)
Presentation Date and Time (Option 3)
Best Time for Presentation?
In Person or Virtual
Age Group for Presentation*
Estimated Audience Size (min. 25 for virtual) *
Brief synopsis of event: *
Were you referred by a Miss candidiate? If so, please let us know! *
For all social media and promtional items, the Real Talk and The Recovery Village logos MUST be included. If not, the program is allowed to cancel the event. Please see below for the logo.

I agreeI do not agree
I understand, our school/organization will be on time to the event. If not, please email ATate@advancedrecoverysystems.com to let us know any technical issues or rescheduling. We will stay on for 15 minutes after the original start time and then cancel the call.

I understand
How did you hear about Real Talk? *
Should be Empty: