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NY Crystal Meth Anonymous Intergroup - Hospitals & Institution's - Speaker Signup Form
Fill out this form to be added to the Hospitals and Institutions Speaker Panel Database

PLEASE NOTE: All your information will only be accessible by the trusted servants of the H&I committee and will not be shared with anyone.
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Email *
First Name & Last Initial *
Email *
City and State *
Phone number *
What is your availability (Nights, Weekends, Any Time, etc.) *
Sobriety Date *
MM
/
DD
/
YYYY
Which locations are you willing to speak at? (Please check all that apply) *
Required
Do you have a car? *
Are you willing to pick up people in your car (we will only ask you to pickup someone local or meet them at a center location - we wont ask you to go an hour+ out of your way) *
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