BeWellPBC Couch Conversations
Community Couch Guest Interest Form
Let's Get To Know You!
We're excited for your interest to join the Couch. Please fill out the form below and we will connect with you soon.
Name
*
First Name
Last Name
E-mail
*
example@example.com
City (In which you identify as a resident)
*
Social Media Handles
*
Rows
Link to Your Profile
Facebook
Instagram
Twitter
Other
Couch Conversations Episode You Would Like To Sit On
*
Please Select
April: Affordable Housing
May: College Students & Mental Health
*Please note Couch Conversations are typically recorded on the 4th Thursday of the month.
What Questions Do You Hope Are Answered On The Respective Couch Selected?
*
*Please include a minimum of two questions.
What Future Couch Conversations Would You Like To Listen To?
*
Please Upload A Fun Headshot Of Yourself
*
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