Notice: Marin County Teleservice does not maintain any of your personal information on this website. The information entered on this form is used soley for the purposes of generating an e-mail message to the appropriate contact person and then discarded.

Your Name (required)

Your Email (required)

Cell Phone (required) xxx.xxx.xxxx

Home Phone (required) xxx.xxx.xxxx

At least 6 months Sobriety? YesNo

Shift Type Interested In: Primary12-Step Worker

Shift Days: MonTuesWedThursFriSat-Sun

Additional information:

Please type the following