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Institutions Speaker Sign-up Form
Institutions Speaker Sign-up Form
2021-07-15T11:07:34-04:00
Your Name
*
Your Email
*
Your Phone number
*
Are you volunteering as a Homegroup or Individually
*
Choose option
For a Group
Individually
Nights Available
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Is your homegroup a Men's or Women's meeting?
*
Women's
Men's
Neither/both
Speak in person?
*
Yes
No
Speak on Zoom?
*
Yes
No
Homegroup Name (if filling for a group)
*
Are you willing to attend Women’s/Men’s/Unisex meetings?
*
Women's
Men's
Unisex
Homegroup Day/Night
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Speak in person?
*
Yes
No
Speak on Zoom?
*
Yes
No
Willing to submit for a background check if required by a jail or institution
Willing to show proof of vaccination if an institution requires it (not all institutions have this requirement)
Submit
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