Service Survey Are you a member of Narcotics Anonymous from the Greater Philadelphia Region? *YesNoThis form is for NA Members only. If you are not an NA Member but wish to contact our fellowship, please enter your reason below.Email AddressNA members from the Greater Philadelphia Region who submit this survey can choose to be entered into a prize drawing. One randomly selected addict will win free registration to WCNA 38, the World Convention of Narcotics Anonymous, which is scheduled to occur in Washington DC from August 29 – September 1, 2024! This prize only includes standard registration- not travel, lodging, food, optional events/excursions, etc. *Got it.Addict InformationFirst Name *Last Initial *Your Clean Date *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year20582057205620552054205320522051205020492048204720462045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958Select any place where you attend meetings regularly. *I only attend meetings virtually.PhiladelphiaBucks CountyChester CountyCamden, NJDelaware CountyMontgomery CountyWhere do you attend meetings regularly in Philadelphia? *I attend meetings everywhere in Philadelphia.Center CityGermantown / Chestnut HillNorth PhillyNortheast PhillyRoxborough / ManayunkSouth PhillyWest PhillyHow often do you attend NA meetings? *Nearly every dayMultiple times per weekOnce per weekA few times per monthRarely or neverServiceDo you have a home group? *YesNoNot sureIdentify the name of your home group *Home groups typically belong to an Area. Do you know which Area your home group belongs to? *YesNoIdentify the name of the Area *Do you know what an NA "service commitment" is? *YesNoDo you have an NA service commitment? *YesNoIdentify ANY/ALL levels where you are currently active in NA service. *Home groupAreaRegionZoneWorldOtherHow are you currently in service in NA? If you currently have a formal commitment, please identify it. *If you could do something more to help us carry the NA message, what would you do? *Follow-UpEmail Address *Phone *Would you like to be added into the prize drawing? *YesNoYou must be an NA member from the Greater Philadelphia Region to be eligible. One randomly selected addict will win free registration to WCNA 38, the World Convention of Narcotics Anonymous, which is scheduled to occur in Washington DC from August 29 – September 1, 2024! This prize only includes standard registration- not travel, lodging, food, optional events/excursions, etc.Are you willing to receive NA-related emails? *YesNoAre you willing to receive NA-related text messages? *YesNoIf you refer us to other addicts, you will earn additional entries into the prize drawing. *I understand.You may provide up to three (3) email addresses and/or three (3) phone numbers. For each email or number you provide, your name will be added into the prize drawing an additional time.Can you provide us with email addresses for other individuals who may be interested in completing this survey? *YesNoWe tell the addict(s) we got the email address from you.Email Address #1 *Email Address #2Email Address #3Can you provide us with phone numbers for other individuals who may be interested in completing this survey? *YesNoWe tell the addict(s) we got the phone number from you.Phone Number #1 *Phone Number #2Phone Number #3 Send Message