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INVITE
First Name
Last Name
Email
Code
Phone
How did you hear about us?
Name of School
Would this event be for middle school or high school students?
How large is your student body?
Position
What is your desired date to host Rewind The Tape?
What areas of mental health do you believe are currently affecting your students?
In what ways have you tried to address the mental health epidemic in your students? What has worked and what has not?
What changes would you like to see in the mental health of your students?
What is the greatest need within your student body?
What would your desired outcome be for inviting Rewind The Tape to your school?
Would you be interested in scheduling an in-person or virtual meeting with Brian beforehand?
Choose an option
Are you ok with someone from our media team taking pictures | video during the event?
Choose an option
Are you ok with us bringing members from our team to help with the event?
Choose an option
Are there any other details you think we should know? What questions do you have?
SUBMIT
Thanks for submitting! We are honored that you have chosen to inquire about partnering with
Dr. Brian Connolly & Rewind The Tape.
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