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REGIONAL SERVICE COMMITTEE REGISTRATION / UPDATE FORM
Thank you for updating your RSC's contact information with NA World Services.
Regional Committee Mailing Address

   
*Your Name:
(First and Last)
*Your Email:
*Committee Name:
*Address/PO Box:
*City:
*State/Prov:
*Zip/Postal:
Country:
Webpage URL address:
Regional Helpline Number:
Helpline serves what
area codes / cities?
Committee was formed
in month/year?
What service committees are included in this NA Region?
(Please provide complete committee names if known.)
   

Regional Delegate Name
 


Regional Delegate Name:
(First and Last)
Address:
City:
State:
Zip/Postal:
Country:
Phone:
Email Address:
 
 


Alternate Delegate Name
 


Alternate Delegate Name:
(First and Last)
Address:
City:
State:
Zip/Postal:
Country:
Phone:
Email Address:
 
 


Regional Service Committee Contact

This is typically contact information and a mailing address of a stable NA member who can forward any communication from NA World Services to the RSC if the RD or AD is unavailable. This may or may not be a current RSC trusted servant. NA World Services frequently receives requests for contacts from professionals; this information will help us to better respond to those requests.



Name:
(First and Last)
Address:
City:
State:
Zip/Postal:
Country:
Phone:
Email Address:
 
 



Regional Service Office Address (if applicable)


RSO Name:
Address:
City:
State:
Zip/Postal:
Country:
Phone:
Email Address:
Contact Name: (First and Last)
 
 


NA World Services maintains contact information for the following trusted servants and subcommittees: Activities, Convention, Hospitals & Institutions, Literature Distribution, Literature Review, Meeting List, Newsletter, Phoneline, Public Relations/Public Information Information Contact, and Website. Please use the following section to forward any of the above contact information.



Name:
(First and Last)
Position:
Address:
 
 
City:
State/Prov:
Zip/Postal:
Country:
Phone:
Email Address:




Name:
(First and Last)
Position:
Address:
 
 
City:
State/Prov:
Zip/Postal:
Country:
Phone:
Email Address:




Name:
(First and Last)
Position:
Address:
 
 
City:
State/Prov:
Zip/Postal:
Country:
Phone:
Email Address:




Name:
(First and Last)
Position:
Address:
 
 
City:
State/Prov:
Zip/Postal:
Country:
Phone:
Email Address:




Name:
(First and Last)
Position:
Address:
 
 
City:
State/Prov:
Zip/Postal:
Country:
Phone:
Email Address:


Additional Information

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If you have any questions or concerns that are not related to this group's registration, please contact info@na.org

 

 

 

 

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