Request the Speakers List

Submit this form to receive a copy of the speakers list.

"*" indicates required fields

Name*
Email*
Please enter your contact phone number in the following format: 212-555-1212
Confidentiality Agreement*

Volunteer to Speak

If you are eligible* to be on the speakers list, please fill in the online form below and we will review and add you to the list. In order to maintain the integrity of our Speakers List, the list is reviewed on an annual basis. You will be required to opt in once per year. This will be as simple as replying to an annual email requesting that you opt in.

*Eligibility includes a minimum of one (1) year of current, continuous abstinence and affiliation with an Intergroup within Region 6

If you are currently on the list and would like to be removed, please send us an email.

Name(Required)
Email(Required)
Address(Required)
MM slash DD slash YYYY
This online form requires complete date. If you do not know the exact date, please enter as close approximation as possible. (Minimum one year of abstience to be included on Speakers List.)
Topics
In order to assist with groups searching for a speaker, please let us know topics for which you have strong recovery in. Special Focus (check all that apply):
Are you available to lead a retreat?(Required)
Preferred Group Size(Required)
How far will you travel?
You may share my contact information with World Service Office:(Required)
You may share my contact information with other Regions:(Required)
We will not share your info with any group outside of Region 6, only with the requesting region.