Region 3 Speaker Application
Twelfth Step Within - Overeater's Anonymous
Email address *
Full Name *
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State *
City
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Contact Number *
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Length of Time in Program *
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Date of Current Abstinence *
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Are you maintaining a healthy body weight? *
Language(s) Spoken *
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Subject(s) about which you would like to speak *
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Preferred Group Size
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How far are you willing to travel? *
Are you willing to speak virtually? *
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