Shadow

    > Please select either the Episode you have been invited specifically to join OR the "Episode - New Topic" if you would like to be on an upcoming episode. (We won't be able to have everyone who applies on a specific show, but we will keep you in mind.)

    >

    >

    >

    >

    > Please select ALL topics you would love to speak about for this or possible future episodes:

    >

    >

    >

    *** Very important About Anonymity:
    The Eleventh Tradition states, “our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio and films.” This is part of the “traditions” of EVERY 12 Step Program.

    To be on our show in the studio, you need to be comfortable NOT mentioning your membership in ANY SPECIFIC 12-step program.

    If you are on the show specifically to share about your experience in a program, we will keep you off-camera and at most, first name or “anonymous caller” only.

    If you are comfortable talking about your recovery which usually encompasses more than just a 12 step program, without specifically mentioning your membership in a 12 step program, then you could be in the studio or on zoom on tv. (you CAN mention having attended a 12 step program, but you cannot say you are or were a member of it or directly speak as a representative). Ex. “I have been to a meeting or two of SAA, and I loved that this about the program…” As long as you do not break your own anonymity as being a member or someone who attended.

    _______________________________
    The REAL Recovery Store Consent & Release Form
    Please fill out the following. You will receive a copy to your email address upon submission.

    I hereby authorize The REAL Recovery Show, PHLV Radio, The Meeting Space, and those acting pursuant to its authority to:
    (1) Record my image, likeness, and/or voice on a photographic, video, audio, digital, electronic, or any other medium;
    (2) Use, reproduce, modify, exhibit and/or distribute any such recording, in whole or in part, in any manner or medium now known or hereafter developed (including without limitation, print publications, DVDs, internet, CD's) for any purpose that The REAL Recovery Show, PHLV Radio, The Meeting Space, may deem appropriate, including without limitation promotional or advertising efforts; and
    (3) Use my name and biographical material in connection with any such recordings or uses. I hereby waive the right to inspect or approve any such recordings and uses . I understand that The REAL Recovery Show, PHLV Radio, The Meeting Space, will be the owner of all such recordings and uses.
    I hereby release and hold harmless The REAL Recovery Show and PHLV Radio from liability for any violation of any personal or proprietary right I may have in connection with all such recordings and uses.

    By clicking "Submit" you agree to the above.