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REGIONAL SERVICE COMMITTEE REGISTRATION / UPDATE FORMThank you for updating your RSC's contact information with NA World Services.

Regional Committee Mailing Address



*Your Name: (First and Last)	*Your Email:

*Committee Name:	*Address/PO Box:

*City:	*State/Prov:

*Zip/Postal:	Country:

Webpage URL address:	Regional Helpline Number:

Helpline serves what area codes / cities?

Committee was formed in month/year?	What service committees are included in this NA Region? (Please provide complete committee names if known.)

Regional Delegate Name


Regional Delegate Name: (First and Last)	Address:

City:	State:

Zip/Postal:	Country:

Phone:	Email Address:

Alternate Delegate Name


Alternate Delegate Name: (First and Last)	Address:

City:	State:

Zip/Postal:	Country:

Phone:	Email Address:

Regional Service Committee Contact
This is typically contact information and a mailing address of a stable NA member who can forward any communication from NA World Services to the RSC if the RD or AD is unavailable. This may or may not be a current RSC trusted servant. NA World Services frequently receives requests for contacts from professionals; this information will help us to better respond to those requests.


Name: (First and Last)	Address:

City:	State:

Zip/Postal:	Country:

Phone:	Email Address:

Regional Service Office Address (if applicable)


RSO Name:	Address:

City:	State:

Zip/Postal:	Country:

Phone:	Email Address:

Contact Name: (First and Last)

NA World Services maintains contact information for the following trusted servants and subcommittees: Activities, Convention, Hospitals & Institutions, Literature Distribution, Literature Review, Meeting List, Newsletter, Phoneline, Public Relations/Public Information Information Contact, and Website. Please use the following section to forward any of the above contact information.


Name: (First and Last)	Position:

Address:

City:	State/Prov:

Zip/Postal:	Country:

Phone:	Email Address:


Name: (First and Last)	Position:

Address:

City:	State/Prov:

Zip/Postal:	Country:

Phone:	Email Address:


Name: (First and Last)	Position:

Address:

City:	State/Prov:

Zip/Postal:	Country:

Phone:	Email Address:


Name: (First and Last)	Position:

Address:

City:	State/Prov:

Zip/Postal:	Country:

Phone:	Email Address:


Name: (First and Last)	Position:

Address:

City:	State/Prov:

Zip/Postal:	Country:

Phone:	Email Address:

Additional Information

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If you have any questions or concerns that are not related to this group's registration, please contact info@na.org

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