📬RCVC "ATO" SUBMISSION FORM

  • 📬RCVC "ATO" REQUESTS

    Please fill out this form if you would like for us to reach out to you to schedule a meeting or phone call. Even if you want to coordinate an event or speaking engagement. We can't wait to hear from you!
  • 📅Date:*
     - -
  • 👥Are you a Peer or Someone Else?*
  • ☎️Phone Number:*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • 👥Preferred Contact Method?*
  • 📅Are their any specific days we should avoid when contacting you?*
  • 🕒Best Time of Day to Contact You:*
  • 🤝🏽Is their anyone in particular that you would like to reach out to you on our team?*

  • IMPORTANT NOTICE

    *Please read before submitting*

  • By selecting " I Give Permission" you are agreeing to the following:

     

    • I grant permission for someone from the GC4R RCVC team to call, text, and/or email me at the provided contact method on the specified days and times (if preference was selected) to discuss the topic stated in the "Reason for Request" section.

    • I understand that someone on the team will attempt up to 3 times to contact me in response to my submitted request form.

    •  I understand that after 3 failed attempts with no call, text, or email back I will need to submit a new form if I would still like to be contacted.

    • Furthermore, I also understand that after the first initial form is submitted, and contact is successfully made I am not expected to submit a contact request form everytime I wish to make contact with someone on the team.

    • I am aware that this form is only to establish initial contact with new peers and potential community partners. I can also use this form if I have not been able to in contact with a specific team memeber, and would like someone to reach out to me.
    • I consent to updates, newsletters, and invitaions to future events from the GC4R RCVC team as they arise.

    • At any time if I may decide not to take part in any further contact, I will contact someone on the team via my preferred contact method.

  • I have read and understood the above statements, and either accept or decline moving forward:*
  • Should be Empty: