Today's Date *
Today's Date
This is my: *
Name *
Name
Address *
Address
Phone *
Phone
SERVICE HISTORY
Type in the length of service for any and all positions you've held.
Area/Region Service
World Service
Are you familiar with Robert's Rules of Order and Parliamentary Procedures? *
Do you have time to prepare for the World Service Conference by attending all committee meetings as needed? *
Attend meetings of the Board of Trustees or World Service Conference Committee, as needed. These meetings are held by Skype conference calls. You will need to have a computer and internet access for these meetings.
Do you have time to serve as a World Service Conference Facilitator? *
The conference will be held over a 5-day period. Your travel days may add an additional day or two.
Personal Information
Leave blank if not applicable
Professional Experience
Additional Information
References
Please list three (3) Nar-Anon members with whom you've performed service work
Reference 1 *
Reference 1
Phone *
Phone
Reference 2 *
Reference 2
Phone *
Phone
Reference 3 *
Reference 3
Phone *
Phone
Signature

Please Note: Although your information is kept confidential, your references and committees you have served on may be contacted.