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Join the H&I Speaker and Servants List
Complete this form to be added to the Western Massachusetts H&I Speaker List. You must have at least three months clean to join the list. To view the list, follow this link:
https://rebrand.ly/speakerlist
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* Indicates required question
It's ok to contact me to speak
*
Yes
No
Required
Are you interested in Speaking at the Jail? If yes, would be willing to submit information for a CORI check?
Yes
No
Clear selection
Name
*
Write your first name and last initial.
Your answer
Phone Number
*
Please enter numbers only, ex. 4135251234
Your answer
Email
*
Your answer
Clean Date
*
You must have at least three months clean to join the speaker list.
MM
/
DD
/
YYYY
City
*
Write the name of the town or city you live in. This helps folks know what speaker to call based on where the commitment is located and where the speaker lives.
Your answer
Do you have interest in being a commitment holder?
*
Yes
No
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