MNSA Group Records Change Form (In Person and Hybrid)
Group Name:
*
WSO ID#
*
Or "unknown"
District #:
*
Please Select
Unkown
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Status
*
Change
Inactive
Change Effective Date
-
Month
-
Day
Year
Date
Summary of Group Changes( Check All that Apply)
Group Name, In Person Meeting Location
Group Name, Hybrid meeting Connection Details
Phone Contact for the Public: Name or Phone #, Group Email Address
Meeting Day Time or other Details
Group Current Mailing Adress: Name, Address, Phone or Email Address
Group Representative: Name, Address, Phone or Email Address
Group Name, In Person Meeting Location
Only information that has Changed
New Group Name
New Meeting Location(in person)
New Meeting Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Location Instructions(in person)
Group Name, Hybrid meeting Connection Details
If this meeting has videoconference information, please enter the full valid URL here. Currently supported providers: Bluejeans, Dialpad, Discord, Free Conference, FreeConferenceCall, Google Meet, GoTo, Jitsi, Signal, Skype, Teams, Virtual Reality, WebEx, Zoho, Zoom. All other Connection details required, can be included in the Notes field below. Phone numbers use this format +12125551212,,123456789#,,#,,444444#
New Group Name
URL
*
https://zoom.us/j/
URL Notes
*
Connection Information: Meeting ID, PC
Phone
Phone Notes
If your Group chooses not to Publish the online Connection Information, supply Email address to contact to recieve Connection Information. (phone #s cannot be used)
example@example.com
Phone Contact for the Public: Name or Phone #, Group Email Address
Contact 1
First Name
Phone # (xxx) xxx-xxxx
Contact 2
First Name
Phone # (xxx) xxx-xxxx
Group Email Address
example@example.com
Meeting Day, Time, or other Details
Day
*
Time
*
Hour Minutes
AM
PM
AM/PM Option
Meeting Attendees
Families and Friend Only
Families, Friends and Observers Welcome
Other Details
Handicap Access
Smoking Permiteed
Limited Access
Child Care
Beginners
Fragrance Free
Sign Langauge
Participants: This information is optional. In keeping with Traditions Three and Five, our groups welcome anyone affected by someone else’s drinking. Every Al-Anon meeting is open to every Al-Anon member
Parents of Alcoholics
LGBTQIA+
Women
Men
People of Color
Young Adults
Please remove... (from above list)
Current Mailing Address (CMA)
Necessary to remain Active.
Name or Location
*
First Name (or Location)
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
CMA (Group)Email
example@example.com
Group Representative
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Submitted By:
*
First Name
Phone # or Email Address
Submit
Should be Empty: