Speaker Sign-Up

Speaker Sign-Up
By completing and submitting this form, you agree to follow the Members Interested in Speaking (G-1) guidelines and to be available as a speaker for District 12 Al-Anon Family Groups looking for speakers. The information you provide will be shared with meetings that request a list of available speakers. If your information changes, please send your changes to grouprecords@alanonventura.org.
Name*
First Name, Last Initial
Email Address*
Phone Number*
Format: (000) 000-0000.
Location (City)*

Street Address

Street Address Line 2

State / Province

Postal / Zip Code
TextPhone CallEmail
When did you join Al-Anon?*

MonthDayYear
Years in Al-Anon
YesNo
In-person meetingsOn-line meetingsPublic institutionsPanelsOther Al-Anon Events
Languages in which you are fluent and are willing to speak*
For in-person meetings, do you have any travel restrictions or accommodation needs?*
Reply N/A if this doesn’t apply
What is your home meeting?*
Include Day and Time
ParentsWomenMenAdult child of alcoholic(s)BeginnersAlateen/AMIASCouples (AA and Al-Anon)Parent/Child (AA and Al-Anon)LGBTQ+General ESHServiceOther
Additional information you’d like to share
Please verify that you are human*
Submission Date

MonthDayYear
Date
Hidden Years in Al-Anon
Should be Empty: