Alcoholics Anonymous Group Information Change Form

Group Information

Is this for a new or existing group:
Group Service Number: Date:
Delegate Area: 25 District Number: Number of members:

OLD INFORMATION

NEW or PRESENT INFORMATION (*required)

Group Name:
Group Meeting Location:
Street:
City/Town:
State:
Zip:

*Group Name:
Group Meeting Location:
*Street:
*City/Town:
State:
*Zip:

MEETING INFORMATION

	Check the days you have meetings and type in the Time, Open or Closed, Type of Meeting ATTENTION! You MUST check the box for the meeting day!
	Mon Time, O/C, Type Time, O/C, Type Time, O/C, Type Time, O/C, Type	Tues Time, O/C, Type Time, O/C, Type Time, O/C, Type Time, O/C, Type	Wed Time, O/C, Type Time, O/C, Type Time, O/C, Type Time, O/C, Type	Thurs Time, O/C, Type Time, O/C, Type Time, O/C, Type Time, O/C, Type	Fri Time, O/C, Type Time, O/C, Type Time, O/C, Type Time, O/C, Type	Sat Time, O/C, Type Time, O/C, Type Time, O/C, Type Time, O/C, Type	Sun Time, O/C, Type Time, O/C, Type Time, O/C, Type Time, O/C, Type

OLD INFORMATION

NEW or PRESENT INFORMATION (*required)

General Service Representative (GSR)

GSR Name:
Telephone:
Street:
City/Town:
State:
Zip:
e-mail:

General Service Representative (GSR)

*GSR Name:
*Telephone:
*Street:
*City/Town:
State:
*Zip:
e-mail:

Select one        Alternate GSR            Mail Contact
Name:
Telephone:
Street:
City/Town:
State:
Zip:
e-mail:

If the Group is to be listed in the directory, please provide a telephone number and mailing address for the G.S.R., Alternate G.S.R., or Group Contact. Listing in the Directory is for Twelfth Step referral and/or for meeting information. The G.S.R.'s (or other contact) name and telephone number will be included in the Directory with the group's name and service number.

Okay to list in the Directory? yes no

Our membership ought to include all who suffer from alcoholism. Hence we may refuse none who wish to recover. Nor ought A.A. Membership ever depend upon money or conformity. Any two or three alcoholics gathered together for sobriety may call themselves an A.A. group, provided that, as a group they have no other affilliation."
--Tradition Three (long form)

Each Alcoholics Anonymous grooup ought to be a spiritual entity having but one primary purpose -- that of carrying its message to the alcoholic who still suffers."
-- Tradition Five (long form)