Tackle The Shackles | Speaker Form

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First name

Last name

Phone

City

State

Church / Organization

Your Story

Please provide a brief overview of who you are and what you do

What is your primary connection to the reentry community? (Check all that apply)

Lived experience (Formerly incarcerated)

Family member/loved one of someone incarcerated

Ministry/Clergy (Chaplain, Pastor, Ministry Leader)

Professional (Social worker, counselor, legal aid, career coach)

Volunteer/Advocate

Other

Speaking Details

Proposed Speaking Topic(s) or Theme(s):

Do you require any specific Audio/Visual equipment? (e.g., Projector, lapel mic, whiteboard)

Upload any Materials

Bio

Professional Bio

Website

Social Media

Professional Headshot

By checking this box, I acknowledge that this is a volunteer speaking opportunity (unless otherwise negotiated) and that my presentation will align with the core faith values of this organization, avoiding partisan politics and focusing on hope, healing, and successful reintegration.