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Thank you for your interest in the Outreach Program. To help us understand your needs and how we can best support your facility, please complete the following questionnaire.

Your Information

Name*

Facility Information

Address
Type of Facility
What type of AA support are you requesting?
MM slash DD slash YYYY
Is this meeting intended for
Is this meeting for

Facility Requirements and Access

Is the facility secure/restricted access?
Will AA volunteers need to be pre-approved or background checked?
Is a staff member required to be present during the meeting?
Will AA volunteers be allowed to bring in literature (pamphlets, books)?
Please provide any additional information that might help us better support your facility's needs.