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Narcotics Anonymous Hospitals & Institutions Meeting Request Form
Professionals Requesting a Narcotics Anonymous Hospitals & Institutions Meeting At Your Facility:
" Please complete the H & I Meeting Request Form and email to nacolorado.org.
" The H & I Chair Marilou L. - 720-318-4924 will contact the prospective facility explaining what NA has to offer and answer any questions about the process for adopting a new meeting.
" Then the H & I Chair will submit facility request to the next subcommittee meeting held on the second Sunday of the month at 6750 Carr in Arvada. To expedite the process, we encourage a representative from the facility (requesting a meeting) to be our guest at the next H & I Subcommittee.
" Committee approval and setting the start date is contingent upon having an adequate number of volunteers from our fellowship step up to conduct new H & I Meeting at your facility.
" We are unable to establish meeting at any facility that requires us to pay fees.
" We welcome you to view a List of Facilities that H & I currently serves.
     Before A Meeting Is Approved:
" The subcommittee elects a panel coordinator as a liaison between the subcommittee and the new facility.
" The panel coordinator solicits enough volunteers to facilitate the proposed meeting.
" Then the panel coordinator reports progress at the next subcommittee meeting wherein a start date is established or not.
    Once A Meeting Is Approved:
" The panel coordinator and the facility contact establish a meeting schedule.
" The panel coordinator submits literature needs to the H & I subcommittee for approval and inclusion in our budget.
" The H & I secretary provides the panel coordinator with a start up folder containing meeting formats, a set of readings, panel coordinator report forms.
Name of Facility:
Today's Date:
Street Address:
Mailing Address:
City:
State :
Zip :
Facility Contact Name :
Phone:
Email :
 Requested Meeting
Days of the Week:
Time:
am:
pm:
Days of the Week:
Time:
am:
pm:
Frequency of Meetings:
Weeky:
Monthly:
Other:
Volunteers Gender/Age Restrictions
Male :
Female :
Both:
Age :
Specific Type of Facility :
Facility Requirements for Volunteers (Training, Orientation):  
Legal Clearances Required For Volunteers:
How Did You Hear About Us?