"Conversations on a Bench" Participant Details Form

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We’re so glad you’re interested in being part of Conversations on a Bench, a 24-hour livestream event hosted by the Eugene Mission on October 9–10, 2025.

Thank you for filling out the form below, we will be using this information to help us thoughtfully build the schedule.

Stay tuned! We will be in touch closer to the event to fine-tune the timing and details of your segment.

Full Name

Email Address

Phone Number *

When are you generally available? 24 hours starts at 12:00pm Thursday October 9th – 12:00pm Friday October 10th

Afternoon

Evening

Late Night

Thursday 9th

When are you generally available? 24 hours starts at 12:00pm Thursday October 9th – 12:00pm Friday October 10th

Before Dawn

Early Morning

Morning

Late Morning

Friday 10th

How are you connected to the Eugene Mission or our community? *

Current Guest

Graduate or past guest of R³ or Life Change Program

Local Community Member

Volunteer

Donor

Clergy or Church Leadership member

Eugene Mission Staff or Board Member

First Responder

Public Servant

Other:

Required

If you selected “other” please describe.

Have a topic you would like to discuss? Let us know what you are most interested in. *

💡General topic: Transformation & Life Change💡

Recovery Journey

Mental Health & Healing

Rebuilding After Loss

Second Chances / Redemption

Finding Purpose

💡General topic: Relationships & Community💡

Family Reconciliation

Friendship / Mentorship

Community Impact

Serving Others

💡General topic: Faith, & Church Community💡

Power of Prayer

Hope in Hardship

Scripture That Sustains

Spiritual Renewal

💡General topic: Making a Difference through Service and Giving

Volunteering at the Mission

Donor Perspective

Community Leadership

First Responder Perspective

💡General topic: Mission Experiences💡

Life in Life Change or R³

Life After Graduation

Hospitality Moments

Being Seen / Known / Valued

First Impressions of the Eugene Mission

Why the Mission Matters to Me

💡General topic: Advocacy & Awareness 💡

What People Don’t See About Homelessness

The Role of Dignity in Recovery

Misconceptions About Poverty or Homelessness

Systems That Harm or Heal & Public Policy

Hopes for Our Community

Other:

Required

If you selected “Other,” please describe.

Thank you!!

We’re honored that you would join us and share your voice at Conversations on a Bench.

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