CMA H&I Panel Interest Form
CMA takes the message of recovery into hospitals, treatment facilities, prisons, and other institutions that house people who are unable to leave to attend meetings. 

Requirements:

Serving on a panel: minimum 6 months sober
Leading a panel: minimum 1 year sober
Serving on or leading a prison panel: 5 years sober

Filling out this form indicates only your willingness to be contacted and asked to serve on/lead a panel. It does not have to indicate a firm commitment on your part.
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Your First Name and Last Initial *
Your Sobriety Date *
MM
/
DD
/
YYYY
Are you interested in serving on a panel? *
What types of panels are you able to participate on? *
Required
Are you interested in leading a panel? *
Days Available *
Required
Times of Day Available *
Required
Do you have a suggestion for a new panel?
Your Phone Number *
Your Email Address *
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