New Registration or Change of Group Meetings and Information
 

Sections Marked * must be completed before submitting:

Group ID Number*:
Your Name :                   Your email address:
Current Group Name*: District Number*:

Type of Group: Al-Anon : Adult Children Disbanded

This is a change of:
Change of Meeting Place :
Change of Day, Time and Place
New Meeting - not yet registered
New Meeting Registration Number
Meeting disbanded temporarily
Meeting disbanded permanently
Change of Group Contact
Change of Group Representative or Alternate

Current/New Group Mailing Address including city and postal code:

If Change of Meeting Place, Day or Time, please Complete the following:

New Meeting Place:

New Meeting Time: Starting time a.m. or p.m. to
                                Finishing Time a.m. or p.m

New Day (or Current Day) of the week

Sunday : Monday Tuesday Wednesday Thursday Friday Saturday

Can this information be updated to the webpage? Yes No

 

If Change of Contact, please Complete the following:

New Group Primary Contact Name (First Name ONLY)
Contact Phone Number of Primary Contact:
(including area code and xxx-xxx-xxxx format (include hyphens)):
Email Address
New Group Secondary Contact Name (First Name ONLY):
Contact Phone Number of Secondary Contact:
(including area code and xxx-xxx-xxxx format (include hyphens)):
Email Address

:

If Change of Group Rep or Alternate, please Complete the following:

New Group Rep (First Name AND Last Name, Please):
Group Rep Phone Number
(including area code and xxx-xxx-xxxx format (include hyphens)):
Group Rep Mailing Address (incl postal code) :
Email Address


Any other information you would like the Group Records Coordinator to Know (or general Comments?) :