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. Due to COVID, this presentation is appropriate for a virtual audience ages 13+, and the minimum audience size is 25 for a virtual event. For any questions, please contact aulbrich@advancedrecoverysystems.com
Name of School or University
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School/University Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Point of Contact (Full Name)
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First Name
Last Name
Title
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Email
*
example@example.com
Phone
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-
Area Code
Phone Number
Presentation Date (Option 1)
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Month
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Day
Year
Date
Presentation Date (Option 2)
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Month
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Day
Year
Date
Presentation Date (Option 3)
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Month
-
Day
Year
Date
Presentation Date and Time (Option 2)
Presentation Date and Time (Option 3)
Best Time for Presentation?
Age Group for Presentation (all audience members must be 13+)
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Estimated Audience Size (min. 25 for virtual)
*
Brief synopsis of event:
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Were you referred by a Miss candidiate? If so, please let us know!
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How did you hear about Real Talk?
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Submit
Should be Empty: