[contact-form to=”[email protected]” subject=”Service Volunteer Information”][contact-field label=”First Name” type=”name” required=”1″][contact-field label=”Last Name” type=”name” required=”1″][contact-field label=”Email” type=”email” required=”1″][contact-field label=”Home Group” type=”text”][contact-field label=”Sobriety Date” type=”text” required=”1″][contact-field label=”Phone” type=”text” required=”1″][contact-field label=”Please check each service opportunity in which you are willing to participate: ” type=”checkbox-multiple” options=”12th-Step Calls,12th-Step E-Mail,Speak at Groups,Step Speaker,Speak at Schools,Bridging the Gap,Prison Meetings,Treatment Facilities Meetings,Public Information,Cooperation w/ Professionals,Special Needs,DIA Office Volunteer,DIA Office Volunteer Alternate,Nightwatch – After-hours Telephones,Conventions”][contact-field label=”Please check the geographic areas you would like to volunteer for: ” type=”checkbox-multiple” options=”Addison,Allen,Argyle,Balch Springs,Bedford,Blue Ridge,Bonham,Bowie,Carrollton,Cedar Creek Lake,Colleyville,Commerce,Cooper,Coppell,Corinth,Corsicana,Dallas-N of Downtown,N of NW Hwy,S of NW Hwy,Dallas-South,Dawson,Denison,Denton,Desoto,Double Oak,Downtown Dallas,Duncanville,Ennis,Euless,Fairfield,Farmers Branch,Farmersville,Fate,Flower Mound,Forney,Frisco,Gainesville,Garland,Grand Prairie,Grapevine,Greenville,Groesbeck,Gun Barrel City,Highland Park,Hillsboro,Irving,Kaufman,Lake Texoma (Sherwood Shores),Lake Whitney,Lancaster,Lewisville,Little Elm,Mabank,McKinney,Mesquite,Mexia,Midlothian,Oak Cliff,Paris,Plano,Ponder,Pottsboro,Prosper,Quinlan (Lake Tawakoni),Red Oak,Richardson,Rockwall,Rowlett,Royce City,Sachse,Seagoville,Seven Points,Sherman,Southlake,St. Paul,Streetman,Sunnyvale,Teague,Terrell,The Colony,University Park,Van Alstyne,Waxahachie,Whitewright,Wortham,Wylie”][contact-field label=”Comment” type=”textarea”]

[/contact-form]