British Columbia Public Relations Resource Request Form
Information
Name
First Name
Last Name
Organization Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Type of Event:
Please Select
Community Presentation
Medical/Treatment Facility
School
Professional Medical
Government
Name of Event if Applicable:
Address of event if different from above:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Event Type
Please Select
One Time/Special Event
Recurring/Regularly Scheduled
Date and Time of Event:
What Audience will be in attendance:
Please Select
Youth under 14
Youth over 14
Treatment Clients
University/Collage
Medical Professionals
Government
Government Military
Government Other
Medical Professional
Estimated Number of Attendees:
Session Information:
As a part of an ongoing effort to improvecommunication between British Columbia Region of NA and our local communities, Narcotics Anonymous frames information and sessions on a variety of topics. In order to effectively engage in dialogue, both preparation and time are needed. This means letting us know what you are interested in and how much time is available on the agenda. It is also important that you provide us with information about what types of sessions you would like Narcotics Anonymous to facilitate and the estimated time for each session. Background information on local issues is also helpful for our planning.
How Much Time is available in your agenda for the presentation
How many session would you like NA to facilitate
Background & Additional Comments
In this section please provide us with any additional information on local issues that your region, area or group may be experiencing. We will be able to use this information to make sure that each session we frame as well as the travelers we send will provide the most benefit.
Submit
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