Formulaire de CANA ACNA pour la banque de personnes ressources
"Addicts helping Addicts"

The Canadian Assembly of Narcotics Anonymous has a mission to carry the NA message to potential members throughout Canada. In our efforts to fulfill our dream we need the assistance of local contacts and resources. If you are interested in helping us accomplish our labor of love, we ask you to please send us information about yourself & your experience.

All information collected will be used only by the Canadian Assembly of Narcotics Anonymous. Your cooperation and assistance is needed and appreciated.

First Name:
Last Name (initial):
Gender:
Current Address:
    Street:
    City:
    Province:
    Postal Code:
Telephone:
Email:
Area:
Region:
Clean Date:
Years in HI:
Years in PI:
Years in Outreach:
Years in Conventions:
Years in Literature:
Years at Region:
Years at Area:
Comments:
Languages Spoken:
 

 

Copyright © 2001-2004 Assemblée canadienne de Narcotiques Anonymes, tous droits réservés