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Welcome!
The Massachusetts White Ribbon Day Pledge
for Men and Boys
Please take the pledge and help #ReimagineManhood by completing the following form.
(Campaign Website:
www.janedoe.org/whiteribbonday
)
*
1.
Please sign by giving us your name:
(Required.)
First Name:
Last Name:
2.
Please give use your title and affiliation.
Your Title:
Your Organization:
3.
I give permission for Jane Doe Inc. to publish my name, affiliation and title in the list of pledge signers on the Web and in publications.
Except as follows:
Please indicate that my company/organization affiliation is for identification purposes only.
Please do not publish my affiliation and title.
4.
Contact Information (optional)
Street Line 1
Street Line 2
City
State
Zip
Daytime Phone
Assistant Name
Assistant Phone
5.
Email Address (optional, but if you give us one, we can thank you!)
Privacy Notice:
Your contact information will be used for internal purposes only and will not be shared with sources outside of Jane Doe Inc. without your expressed permission.
6.
Agreements, (optional, please check all that apply)
I promise to wear the white ribbon on White Ribbon Day in Massachusetts.
I promise to recruit 5 friends and colleagues to wear the white ribbon with me.
I have a few ideas about reaching more men, contact me.
7.
(optional)
I would like to make a donation to Jane Doe Inc. in the amount of:
