GSR Forum - GSR Information Update

A.A. Group Information Change Form

GROUP SERVICE No.

DATE

Date

DELEGATE AREA No.

Please provide the group information that is currently listed the the Area 48 Meeting Schedule

GROUP NAME

District #*

Approximate Number of members

Group Meeting Location

Chruch or bldg. Name (1st Fl, basement, etc.)

Street

City/Town

State

Zip Code

Telephone

Is any of the Group Information (above) changing?

YesNo

Please provide the meeting time(s) currently listed in the Area 48 Meeting Schedule

MON

TUE

WED

THUR

FRI

SAT

SUN

Are you changing meeting days or time(s)?

YesNo

Since the meeting information above is changing, please enter the information that is relevant going forward. Complete all fields.

GROUP NAME-

Group Meeting Location-

Street-

City/Town-

State-

Zip Code-

Telephone-

New meeting days/time(s)

MON - (new)

TUE - (new)

WED - (new)

THUR - (new)

FRI - (new)

SAT - (new)

SUN - (new)

General Service Representative (GSR) Information

Are you registering as a new GSR?

YesNo

Enter the new GSR contact information

Name

Street

City/Town

State

Zip Code

E-mail

example@example.com

Telephone

Do you know the previous GSR contact information?

YesNo

Enter the contact information of the previous GSR

Name

Street

City/Town

State

Zip Code

E-mail

example@example.com

Telephone

Is this a new registration for ?

Alternate G.S.R.U.S. Mail ContactNeither

Do you know the previous Alternate GSR/Mail contact information?

YesNo

Enter the "New" Alternate GSR or Mail contact information

Name

Street

City/Town

State

Zip Code

E-mail

example@example.com

Telephone

Do you know the contact information of the former Alternate GSR or previous Mail Contact being replaced?

YesNo

Enter the "Old" Alternate GSR or Mail contact information

Is this contact information for a previous?

Alternate G.S.R.Group U.S. Mail Contact

Are you providing information for the previous Alternate GSR or Mail Contact?

Alternate GSRPrevious Mail Contact

Name

Street

City/Town

State

Zip Code

E-mail

example@example.com

Telephone

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.

Is it OK to list in the directory?

YesNo

Signature

Clear

DATE

Date

“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 affiliation.” — Tradition Three (the long form) “Each Alcoholics Anonymous group ought to be a spiritual entity having but one primary purpose — that of carrying its message to the alcoholic who still suffers.” Tradition Five (the long form) “Unless there is approximate conformity to A.A.’s Twelve Traditions, the group can deteriorate and die.” — Twelve Steps and Twelve Traditions, page 174.

mon

tue

wed

thur

fri

sat

sun

mon*

tue*

wed*

thur*

fri*

sat*

sun*

Check Mark Value

Alternate GSR

U.SMail Contact

Reply to email

example@example.com

Alt GSR*

Alt Mail*

Area 48 GSR Forum - Group Information Update

GSR Forum - GSR Information Update

example@example.com

Fields Below are check boxes for PDF Meeting Days