H&I Speaker Form

Are you a member of Narcotics Anonymous? *YesNo

This form is for NA Members only. If you are not an NA Member but wish to contact the H&I Subcommittee, please enter your reason below.

Email Address

First Name *

Last Initial *

Phone *

Your Clean Date *

Month

Day

Year

Are you willing to speak at a virtual meeting via Zoom? *YesNo

Are you willing to speak at H&I meetings outside of where you attend meetings regularly? *YesNo

Which day(s) are you generally available? *Any day of the weekMy schedule varies. Contact me for availability.Only Certain Days (Option to choose available days will appear)

Are you willing to receive emails when a chair of an H&I commitment is in need of a speaker? *YesNo

Email Address *

Are you interested in learning more about taking on a regular H&I commitment? *YesNoWe are in need of addicts who are willing to serve as panel leaders and members.

The purpose of this form is to identify NA members who are willing to speak at H&I commitments in the Greater Philadelphia Region of Narcotics Anonymous.

Select any place where you attend meetings regularly. *

Where do you attend meetings regularly in Philadelphia? *

If you are only available to speak on certain days, please check all that apply. *