MadManPlant 2026 AAC Mental Health Panel

*NOTICE
Please ensure that all the information is correct before submitting the form. Incomplete, incorrect, or fake details will result in the application being rejected.

Please take the time to fill out this form in detail.
Quick responses or rushed answers will result in the termination of your application. This form is designed to help us dive deep and build meaningful conversations during our panel discussions. We’re looking for individuals who are genuinely committed to providing solid value and insight to the platform.

Thank you for your understanding and for taking the process seriously.

Full name*

First NameLast Name

Pronouns (optional)*

Email address*

example@example.com

Phone number*

Please enter a valid phone number.

City and State*

Organization or brand*

Website or main social handle*

Are you available in person on January 31, 2026, for the full 90-minute panel, plus 15 minutes pre-check-in?*

YesNo, If not available for the full duration, you are not a good candidate for this program.)

Do you agree to arrive 30 minutes before the session start and remain until it ends?*

YesNo

Are you comfortable with the session being recorded and clips used for educational and community purposes? This is Recorded LIVE.*

YesNo

In one sentence: What does “grounding” mean in your life?*

Briefly describe a grounding practice you actually use (e.g., intentional dosing, breathwork, cultivation ritual, journaling, movement). How often do you use it and what changes when you do?*

Describe a moment when you shifted from spiraling to sequencing (from overwhelm to one-next-step). What helped?*

What role, if any, does cultivation or plant care play in your mental health?*

What supports do you need in the room to feel safe and present? (e.g., content warnings, pacing, breaks, water, seating)*

Who is your community? (e.g., veterans, caregivers, patients, parents, creatives, cultivators, disability advocates)*

How do you currently share or support others around mental health or plant-based healing? (formal or informal)*

What practical takeaway could you offer attendees in under two minutes? (e.g., a dose framework, a ritual setup, a journaling prompt)*

After the panel, how would you carry this conversation forward for your community over 30 days? (e.g., host a check-in, share resources, start a small group practice, document a ritual series)*

In one paragraph: Why do you want to be on this panel in 2026?*

This panel prioritizes ethical vulnerability (sharing truth that stabilizes the room rather than flooding it). How do you navigate that line?*

What topics are off-limits for you on stage? (optional but encouraged)*

Are you willing to use the panel’s structure (timed segments, one-sentence lightning rounds, one clear takeaway) to support safety and clarity?*

YesNo

Accessibility needs we should plan for:*

Do you consent to on-site photography and short-form video clips for educational/community awareness?*

YesNo

Do you consent to being contacted for a short prep call and a post-panel reflection?*

YesNo

I agree to share one clear takeaway and to practice ethical vulnerability.
I’m here to ground, grow, and give back not to promote self/products.
I confirm that my participation in the MadManPlant LLC / SmokeBusters Media & Vindec EU meet and greet is a voluntary decision.
I recognize that my conversations and conduct are my own responsibility and do not represent the views or policies of MadManPlant LLC or its affiliates.
I accept full responsibility for my actions, particularly those that may contravene legal or ethical standards.
I consent to the use of my likeness, voice, and content provided by me during the podcast recording for promotional and informational purposes by MadManPlant LLC / SmokeBusters Media & Vindec EU.
I recognize that MadManPlant LLC / SmokeBusters Media & Vindec EU does not promote or partake in illegal activities. I commit to adhering to all relevant laws while participating in the meet and greet, understanding that any legal violations are my sole responsibility, not MadManPlant LLC / SmokeBusters Media & Vindec EU.
I pledge to maintain a professional, courteous, and respectful demeanor throughout the meet and greet. I understand that causing disruptions or engaging in conflict may result in my immediate removal to safeguard the event's integrity and the safety of all participants.

I acknowledge and agree to the commitment statement above.*

I acknowledge and agree

Signature*

Date*

Date

Short bio (150 words)*

Headshot (optional)*

MadManPlant 2026 AAC Mental Health Panel

Contact and Basics

Eligibility and Availability

Grounding, Lived Experience, and Practice

Community and Contribution

Alignment and Readiness

Accessibility and Consent

Commitment Statement

Attachments