BC Region Resource Request Form

This form is for professionals, Government and Community Organizations to request presentations or more information about Narcotics Anonymous.

Your Information
Name Name First Last
Email
Phone Phone - ### - ### ####
Organization Name
Organization Address Organization Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Type of Event/Presentation
Name of Event if Applicable
Address of Event if different from above Address of Event if different from above
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Type of event

Type of event One Time-Special Event Reacurring-Regulary Scheduled
Date of Event Date of Event / MM / DD YYYY
Start Time of Event Start Time of Event : HH MM
End Time of Event End Time of Event : HH MM
Type of Audience in Attendance
Estimated Number of Attendees
Session Information:

As a part of an ongoing efforts to improve communication between British Columbia Region of NA and our local communities, Narcotics Anonymous frames information and sessions on a variety of topics. In order to effectively engage in dialogue, both preparation and time are needed. This means letting us know what you are interested in and how much time is available on the agenda. It is also important that you provide us with information about what types of sessions you would like Narcotics Anonymous to facilitate and the estimated time for each session. Background information on local issues is also helpful for our planning.
How Much Time is available in your agenda for the presentation
Comments/Additional Information
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BC Region Resource Request Form

BC Region Resource Request Form

Your Information

Session Information: