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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