Regional Service Committee Registration / Update Form  
     Thank you for updating your RSC’s contact information with NA World Services.
Regional Committee Mailing Address (Please print clearly)
Committee Name	Today’s Date	
Address/PO Box	
City	State/Prov	Zip/Postal	
Country	Webpage URL address	
Regional Helpline Number (            )	Helpline is based in what city?	
How many NA groups?	How many NA meetings?   	Committee was formed in month/year?	
What NA areas does this region serve? 	

Regional Delegate Name		
Address		
City	State/Prov	Zip/Postal	
Country	Phone (              )	
Email Address		
Send me The NA Way Magazine – (circle one)  Paper  or  Email    (circle one)  English   French  German   Portuguese   Spanish	
	
Alternate Delegate Name		
Address		
City	State/Prov	Zip/Postal	
Country	Phone (              )	
Email Address		
Send me The NA Way Magazine – (circle one)  Paper  or  Email    (circle one)  English   French  German   Portuguese   Spanish	
Regional Service Committee Contact
This is typically contact information and a mailing address of a stable NA member who can forward any communication from 
NA World Services to the RSC if the RD or AD is unavailable. This may or may not be a current RSC trusted servant. NA World Services frequently receives requests for contacts from professionals; this information will help us to better respond to those requests.
Name	
Address	
City	State/Prov	Zip/Postal	
Country	Phone (              )	
Email Address	
Send me The NA Way Magazine – (circle one)  Paper  or  Email    (circle one)  English   French  German   Portuguese   Spanish	
Regional Service Office Address (if applicable)	
RSO Name		
Address		
City	State/Prov	Zip/Postal	
Country	Phone (              )	
Email Address		
Contact Name	
NA World Services maintains contact information for the following trusted servants and subcommittees: Activities, Convention, 
Hospitals & Institutions, Literature Distribution, Literature Review, Meeting List, Newsletter, Phoneline, Public Information, and Website. 
Please use the following section to forward any of the above contact information. 	

Name	
Position: 	

Address	

City	
State/Prov	
Zip/Postal	

Country	
Phone (              )	

Email Address	

Send me The NA Way Magazine – (circle one)  Paper  or  Email    (circle one)  English   French  German   Portuguese   Spanish	

	

Name	
Position: 	

Address	

City	
State/Prov	
Zip/Postal	

Country	
Phone (              )	

Email Address	

Send me The NA Way Magazine – (circle one)  Paper  or  Email    (circle one)  English   French  German   Portuguese   Spanish	

	

Name	
Position: 	

Address	

City	
State/Prov	
Zip/Postal	

Country	
Phone (              )	

Email Address	

Send me The NA Way Magazine – (circle one)  Paper  or  Email    (circle one)  English   French  German   Portuguese   Spanish	

	

Name	
Position: 	

Address	

City	
State/Prov	
Zip/Postal	

Country	
Phone (              )	

Email Address	

Send me The NA Way Magazine – (circle one)  Paper  or  Email    (circle one)  English   French  German   Portuguese   Spanish