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)
Please sign by giving us your name:

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* 1. Please sign by giving us your name:

Please give use your title and affiliation.

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* 2. Please give use your title and affiliation.

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:

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* 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:

Contact Information (optional)

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* 4. Contact Information (optional)

Email Address (optional, but if you give us one, we can thank you!)

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* 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.
Agreements, (optional, please check all that apply)

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* 6. Agreements, (optional, please check all that apply)

(optional)
I would like to make a donation to Jane Doe Inc. in the amount of:

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* 7. (optional)
I would like to make a donation to Jane Doe Inc. in the amount of:

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