Your Email Address
Your Phone Number
> 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.)
Click Here To SelectEpisode 1: Anonymity & Pilot ShowEpisode 2: What Does Addiction or A Bottom Look Like?Episode 3: Where Can I Find Help For Myself or a Loved One?Episode 4: Feelings in RecoveryEpisode 5: Young People in RecoveryEpisode 6: Sex Industry & RecoveryEpisode 7: Sex Industry & Recovery & SpiritualityEpisode 8: EMDR Therapy (Eye Movement Desensitization and Reprocessing)Episode 9: Sober Living in Las VegasEpisode 10: The Inside Scoop on Meeting SpacesEpisode 11: Q&A Newcomers ask OldtimersEpisode 12: Brainspotting for PTSDEpisode 13: Freedom Is A State of MindEpisode 14: LGBTQ in Recovery - Q&A asking OldtimersEpisode 15: Food Addiction, Gastric Sleeve Surgery & RecoveryEpisode 16: Veterans in RecoveryEpisode 17: Gratitude & Thanksgiving / HolidaysEpisode 18: Body Image, Sexual Healing in RecoveryEpisode 19: Food Addiction, Intermittent Fasting & RecoveryEpisode 20: Blackout Girl Interview with JenniferEpisode 21: Xmas, Family, How to Live ONE Day at a Time vs New Year's ResolutionsEpisode 22: Anger Management & RecoveryEpisode 23: Shine A Light - Out Of The TunnelsEpisode 24: Celebrate Recovery - Christianity in RecoveryEpisode 35: AA Story - Cancer & The Recovery MindsetEpisode 36: Narcan & Preventing OverdoseEpisode - New Topic
> Sub-Topics (List clear ideas you can easily talk about in relation to the main topic – based on your personal, education or work experience.)
> Red-Topics (List what you will NOT want to talk about – if anything.)
> *TV/RADIO: (MUST PICK ONE! Please select what method you feel comfortable using - see also "About Anonymity" below)
MUST SELECT ONEIn studio on TV & Radio (cannot mention direct affiliation with any 12 Step Program)On Zoom on TV & Radio (cannot mention direct affiliation with any 12 Step Program)On Zoom on Radio ONLY (this way you CAN mention you are a member of a 12 Step Program)On Phone Call to Studio for Radio ONLY (this way you CAN mention you are a member of a 12 Step Program)No Preference
> Your experience (ex. How have you directly experienced today’s topic? Do you have degrees, or length of abstinence?)
> Please select ALL topics you would love to speak about for this or possible future episodes:
12 Step Recovery - on Sponsorship12 Step Recovery - What To ExpectACT - Acceptance & Commitment TherapyAffirmations & Solution Based ThinkingBiofeedback TherapyBody Dysmorphia - Body Image IssuesBrainspotting Therapy (for PTSD)Bringing Meetings to Hospitals/InstitutionsCelebrate RecoveryCBT - Cognitive Behavioral TherapyCodependency Recovery - Boundaries, DetachmentDating/Relationships in RecoveryDBT - Dialectical Behavioral Therapy (for Suicidal Ideation)Domestic ViolenceDual DiagnosisEFT TappingEMDR - Eye Movement Desensitization & Reprocessing Therapy (for PTSD)Feelings in RecoveryFixing the Effects - General HealthFixing the Effects - Meth MouthFood Addiction & Diabetes, Heart Disease and other effectsFood Addiction - Anorexia & BulimiaForgiveness of Self & OthersGamblingGrowing up in Addiction/DysfunctionHealing the Addiction Stigma in SocietyHow To Help Someone Else without Losing Yourself/Enabling themHow to make AmendsHow to PrayHow to talk to Doctors in RecoveryLong Term Recovery - ToolsMeditationMI - Motivational Interviewing Therapy (for Addiction)MindfulnessNeurofeedback TherapyNot a Glum Lot - Having Fun without Drugs/AlcoholOn Feelings - Facing Fear & AnxietyOn Feelings - Grieving vs DepressionOn Feelings - Peace vs ApathyOn Feelings - AngerOn Feelings - Shame, Guilt, Low Self EsteemOops! Do I need to set a New Sober or Clean Date?Pain Management in RecoveryParenting in RecoveryPowerlessnessPrinciples vs PersonalitiesREBT - Rational Emotive Behavior TherapyRecovering in PrisonRecovering Out LoudRehabsRelapse PreventionSex in RecoverySex IndustrySober LivingTaking Medication - clean & sober?The God Issue - Finding a Higher PowerThis Too Shall Pass - Facing ChallengesThrough The Tunnel - HomelessnessTrauma YogaU RecoveryUnderearning/Spending AddictionUnmanageabilityWhat COVID was likeWorkaholism
> Other Ideas for related or future topics YOU would be interested in speaking on: (We would love to keep you in mind for something that also might be up your alley)
> Suggestions for other people to be on the show? (Please list names and contact info)
> Questions? (Please list concerns or special needs or just about what to expect.)
*** 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.
I have read and fully understand and consent to the terms and conditions of this release
By clicking "Submit" you agree to the above.