Team Up for Hope Interview Intake Form
Thank you for your interest to be a guest in one of our webinars! We look forward to learning more about how mental illness and addiction influenced you to be the person you are today. Please give us as much detail as you can in your answers!
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Your Name (pronunciation if necessary) *
Would you like us to keep you anonymous? If so, we can have your interview posted as a podcast. *
Email *
Phone Number *
Website address
Street address
Are you part of an organization that deals with mental illness and/or addiction? If so, please provide the name of the business you work with.
Do you have any certifications and/or professional designations relating to mental illness and/or addiction?  If so please list your credentials here.
In most cases we like to make a donation to a charity of the interviewees choice. Do you have any organizations that you would like to see a donation made to?
Do you have another platform related to this topic that you'd like us to promote?
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