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Speaker Request Form
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Name:
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Your answer
Contact info:
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Your answer
NA Area:
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Your answer
Do you believe you have a clear message of NA?
*
Yes
No
What do you believe is a chair message of NA?
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Your answer
How long have you been clean?
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Your answer
Do you have a sponsor?
*
Yes
No
Do you have a working knowledge of the 12 steps and 12 traditions?
*
Yes
No
Are you prescribed any MAT medications or mind or mood altering medications (including medical marijuana) that may make it difficult for you to speak at the convention?
*
Yes
No
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