North Florida Area Al-Anon Registration/
Group Records Change Form
(1) WSO I.D. Number      District Number      Area Number  09
(2) New Registration: (check one)
   Yes    No    Not Sure if Registered
(3) Group is: (check one)
   Al-Anon    Alateen *(mail Sponsor form if new)*    Al-Anon Adult Children    Institution
   Group Type:  
(4) Changes: (check all that apply)
Current Mailing
Address (CMA)		 Group Name Mtg Place Mtg Time

Mtg Day GR Contact

Sponsor *(also mail in new Sponsor form)* Disbanded

(5) Features: (check all that apply)
Open Closed Beginners Non-Smoking
Babysitting Signing (ASL) Handicap Access

Language Spoken
Mailing Language
Special Instructions, (i.e. use back door, etc.)

(6) Current Mailing Address: (All group mail will be sent to this address)
First Name:
Last Name:
Street Address:

City
State/Province:
FL
Zip/Postal Code Country: US

(7) Group Name:

(8) Meeting Place:

(9) Meeting Address:
City: State/Province: FL
Zip/Postal Code: Country: US

(10) No. of Members:

(11) Day:
Sunday Tuesday Thursday Saturday
Monday Wednesday Friday Time: : AM PM

Sunday Tuesday Thursday Saturday
Monday Wednesday Friday Time: : AM PM

(12) Contacts:(To be used for Twelfth Step referrals and requests for meeting info.)

Name (first): Phone Number
Name (first): Phone Number

(13) Group Representative:
First Name:
Last Name:
Street Address:
City
State/Province:
FL
Zip/Postal Code: Country: US
Phone:
 

Please enter your e-mail address: