REGIONAL H&I REPORT FORM*
(RSC H&I TO WSC H&I) (Please make report quarterly)
DATE: _____________________________
NAME OF REGION __________________ DATE OF LAST REPORT _____________
NAME OF H&I CHAIR _______________ PHONE NUMBER: () ______ - ______
MAILING ADDRESS FOR SUBCOMMITTEE _________________________________
______
HOW MANY TREATMENT MEETINGS? _____________________________________
HOW MANY CORRECTIONAL MEETINGS? _________________________________
NUMBER OF AREAS IN REGION __________________________________________
NUMBER AT LAST REPORT ______________________________________________
NUMBER OF AREAS PARTICIPATING ______________________________________
PLEASE ATTACH A MAILING LIST FOR ALL OF YOUR AREA H&I SUBCOMMITTEES.
WHAT IS YOUR BUDGET? _______________________________________________
HOW MUCH IS ACTUALLY SPENT? ________________________________________
OTHER TYPES OF SERVICES H&I IS PERFORMING: _________________________
______
ANY PROBLEMS YOUR SUBCOMMITTEE HAS ADDRESSED? _________________
______
______
______________________________________________ (USE ADDITIONAL SHEETS IF NECESSARY)
SPECIAL SUCCESSES SINCE THE LAST REPORT ____________________________
______
______________________________________________ (USE ADDITIONAL SHEETS IF NECESSARY)
ANY SERVICE OR INFORMATION WSC H&I CAN PROVIDE TO YOUR EFFORTS?
______
______________________________________________ (USE ADDITIONAL SHEETS IF NECESSARY)
OTHER COMMENTS? ____________________________________________________
______
______________________________________________ (USE ADDITIONAL SHEETS IF NECESSARY)
WSC H&I POOL NOMINEE INFORMATION SHEET*
We as members of the ____________________________ Region would like to
nominate ___________________ as a WSC H&I Committee H&I Pool Nominee. We
believe he/she would be a valuable participant in the efforts of this committee. We agree to assist, if possible, in the financing of his/her travel to one or more committee meetings held outside of our region once elected as a voting member, so that our worldwide fellowship might benefit from his or her knowledge or experience.
Nominees do not have to be an RSR or RSR-Alternate. The most important requirements are, H&I experience and time to do the work. Only one (1) member per region may be in the nominee pool at a time. Members will be removed from the nominee pool for the following reasons:
• Relapse
• Misappropriation of fellowship funds
Date: __________________________________________________________________
Name: ________________________________________________________________
Address: _______________________________________________________________
Phone: () __________ - __________
Clean Date: ____________________________________________________________
RSC Name: ____________________________________________________________
Current NA service positions: ____________________________________________
Previous NA service positions completed:
Previous NA service positions not completed:
Additional H&I service related experience:
Life experience which may help you with this committee: ___________________
Is regional H&I subcommittee able and willing to support specific assigned tasks
with input to WSC H&I? _________________________________________________
___________
SUBSCRIPTION ORDER FORM*
Reaching Out is a quarterly recovery-oriented newsletter made available free of charge to incarcerated addicts through the World Board of Narcotics Anonymous. It contains letters written by Narcotics Anonymous members who are in hospitals, institutions or involved in H&I service. This newsletter is available by subscription to NA members, correctional facilities, service committees, or anyone else who is interested. For the yearly price of $31.00, the subscriber will receive 20 copies of the Reaching Out newsletter mailed quarterly.
Please send me __________ subscriptions @ $31.00 each Total $ ____________
Send subscription to: ___________________________________________________
Please send a gift subscription to: ________________________________________
From _________________________________________________________________
(A letter will announce your gift) (please type or print clearly)
Name ______________________________________________________
Address ____________________________________________________
City ________________________________________________________
State/Province ______________________________________________
Zip/Postal Code _____________________________________________
Country ____________________________________________________
Please enclose check or money order with your order
Mail to:
Reaching Out PO Box 9999 Van Nuys, CA 91409
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