WAI Confidential 12-Step Sign-Up Form

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Submit this form to be added to the WAI 12-Step list. WAI uses the 12-Step list to help the still sick and suffering. Your anonymity is protected. THANKS FOR YOUR SERVICE! For a printable form: https://aaworcester.org/Docs/Public/12Step_Signup_Form.pdf

First Name & Last Initial

Phone Number

Email Address

Towns you will accept 12-Step calls from:

Hours/Days you are available to help:

Gender willing to help:

Males Only

Females Only

Both

Clear selection

Ages I am willing to help

Teens

20 - 30

30 - 40

40 - 60

60+

All of the above

Clear selection

Hours/Days I am available to help:

Special Skills (bilingual, sign language, etc)

I am willing to accept these types of 12-Step Calls:

Talk or email with a person

Give rides to A.A. meetings

Meet someone at an A.A. meeting

Visit a person's home to talk (*)

Take a person to a detox/treatment facility (*)

Submit

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