Group Change Form

Group Service No.*
Delegate Area No.*
District No.*
No. Of Members*
Date*
Old Information
Group Name*
Group Meeting Location*
Street Address City State / Province / Region ZIP / Postal Code
Telephone
General Service Representative (G.S.R.)
Name*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Telephone*
E-mail*
(Please Check One)
*
- Alternate G.S.R.
- Mail Contact
Name*
Street Address City State / Province / Region ZIP / Postal Code
Telephone*
E-mail*
New Information
Group Name*
Group Meeting Location*
Street Address City State / Province / Region ZIP / Postal Code
Telephone
General Service Representative (G.S.R.)
Name*
Street Address City State / Province / Region ZIP / Postal Code
Telephone*
E-mail*
(Please Check One)
*
- Alternate G.S.R.
- Mail Contact
Name*
Street Address City State / Province / Region ZIP / Postal Code
Telephone*
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.

Ok to list in the Directory
*
- Yes
- No
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

Alcoholics Anonymous