Group Change Form that looks like PDF

    Date:

    DELEGATE AREA No:

    DISTRICT No:

    No. OF HOME GROUP MEMBERS:

    Old Information

     

    New Information

    Group Name

    Street

    Street

    City/Town

    City/Town

    State

    State

    Zip Code

    Zip Code

    Phone

    Phone

    Meeting Day(s)

    Meeting Day(s)

    Meeting Time(s)

    Meeting Time(s)

    GENERAL SERVICE REPRESENTATIVE (G.S.R.)

    GENERAL SERVICE REPRESENTATIVE (G.S.R.)

    Name

    Name

    Address

    Address

    City/Town

    City/Town

    State

    State

    Zip Code

    Zip Code

    Phone

    Phone

    Email

    Email

     

     

    Alternate GSR or Mail Contact check one

    Alternate GSR or Mail Contact check one

    Name

    Name

    Address

    Address

    City/Town

    City/Town

    State

    State

    Zip Code

    Zip Code

    Phone

    Phone

    Email

    Email

     

     

     

    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

    “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.