Philly Brain Break RSVP
Register for the free event and share your brain health interests and content ideas.
Attendee Registration
Full Name
*
First Name
Middle Name
Last Name
Email
*
example@example.com
Phone
Please enter a valid phone number.
Format: (000) 000-0000.
ZIP Code
*
Organization / Business
Number Attending
*
How Did You Hear About Us?
Please Select
Instagram
Facebook
Philly 4 Real TV
Kanvas
Friend
Flyer/QR Code
Other
Are you interested in vending?
Yes
No
Brain Health Interests
Which brain health topics are you interested in?
*
Nutrition
Exercise
Sleep
Stress Management
Social Connection
Self-Care Planning
Family Wellness
Future Workshops
Bible Study
What wellness goal would you like to work toward?
Kanvas Event Package Interest
TURN YOUR IDEAS INTO CONTENT. BUILD YOUR BRAND. EXPLORE TELEVISION.
Kanvas Event Center and Philly 4 Real TV Network are exploring opportunities for creators, businesses, and organizations to develop content and explore an on-demand channel on Philly 4 Real TV. Expressing interest does not commit you to a purchase or guarantee revenue or TV placement.
Would you like to receive package information?
*
Yes, contact me
Yes, invite me to an information session
Maybe, send details
Not at this time
What are you interested in?
*
On-demand TV channel
Interviews/podcasts/talk shows
Business or educational programming
Promotional videos
Advertising sales opportunities
Sponsorships and partnerships
Content production assistance
CUSTOM T SHIRT & MERCH
Are you content-ready?
*
Yes, existing videos
An idea that needs production
I want to learn content creation
Preferred follow-up method
*
Email
Phone
None
Optional budget range
Please Select
Under $100
$100–$250
$251–$500
Over $500
Seeking sponsored options
Prefer to discuss
Come Prepared to Create Content
Instructional text
Would you like to be interviewed or recorded?
*
Yes
No
Tell me more
What topic or content idea would you like to feature?
Media Release Consent
Media Release Notice
Consent
*
I have read and agree to the Media Release and Content Use Consent above.
Legal Name
*
First Name
Middle Name
Last Name
Consent Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Register
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