Al-Anon/Alateen Group Registration / Group Records Change Form

Section 1: Submitter's contact details
Your name*

First NameLast Initial
Your phone*
Your email*
example@example.com
Section 2: What is your change about...
Notification type:*

Change to existing groupRegistration of new group
Something else?
Use this field for a short message or a further clarification of your change
This change is effective:*

DayMonthYear
Enter the date that the change will start on

Is this Registration or Group Record Change for a Permanent Electronic Group?*

YesNo
Group Registrations and Group Records Changes for Permanent Electronic Groups need to be made through World Service Office.

Please visit World Service Office Group Records or call (613) 723-8484.

Is this Group Records Change Form in relation to a Alateen Group?*

YesNo
Group Al-Anon Member In Alateen Service (AMIAS) Sponsor - Must be certified through Ontario South*

First NameLast Name
WSO ID / Group number*
Use 9999 to register a new group
District ID*
Enter 00 to register a new group
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Are there additional Group Sponsors/Contacts for this Alateen Group? (must be a certified AMIAS with Ontario South)

YesNo
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.

Section 3: Group Identity
WSO ID / Group number*
Use 9999 to register a new group
District ID*
Enter 00 to register a new group
Group Format*

In-personHybridOnline / electronic
WSO ID
Placement in Local District or District 33 (Overlay District) discussed with Group Records Coordinator?*

YesNo
Group name*
Group email
PERSONAL EMAILS/NAMES ARE NOT ACCEPTED!
Spoken meeting language

Section 4: Phone Contacts For The Public (max 3)

Phone Contacts for the Public are members willing to receive calls from newcomers seeking Al-Anon’s help or others seeking directions or additional information about the Al-Anon meeting. Contact phone numbers are given out to callers on the WSO toll-free meeting information line and other phone lines. They are never published online. Only first names are required.
Do you need to make a change to your Phone Contacts for the Public?*

YesNo

5.2 Current Mailing Address (CMA)
Every group must have a CMA listed with WSO. If your Group Representative is also your CMA, you do not make changes to this section.
Do you need to make changes to your group's Current Mailing Address (CMA)?*

YesNo
Name*

First NameLast Name
Phone number*
Email*
example@example.com
CMA Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing language

Section 6: In-person Meeting Location Details
Do you need to change information about your group's in-person meeting location?*

YesNoN/A
Name of physical meeting location*
Please enter the name of the location here, not just a city
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Location notes (building, meeting room, accessibility)
E.g. directions, accessibility, etc
Accessibility and other special features (check all that apply)

Wheelchair accessBabysitting availableSigning (ASL) availableNo food / drink allowedFragrance Free

	Yes	No
Beginner meeting
Concurrent with Alateen meeting
Concurrent with AA meeting
Regular (Discussion) meeting
Book study
Step study
Speaker meeting

	Yes	No
Newcomer meeting
Concurrent with Alateen meeting
Concurrent with AA meeting
Regular (Discussion) meeting
Book study
Step study
Speaker meeting

Section 3: Group Identity