Group Information Form (CHANGE)

IMPORTANT: Use this form for reporting changes to an existing group previously submitted. You will also want to submit update information to Area 57 here (Information reported to the Area is forwarded to the A.A. General Service Office (G.S.O.)). If you need to submit new group information for a new group, click here.

- Submitter's Information -

Name of Person Submitting This Form(Required)

First Last

Submitter's Email(Required)

Submitter's Phone(Required)

- Group Information -

Group Name(Required)

District

(If Known)

Group Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Location Information

For example: "Episcopal Church" or "Use South door"

- Group Contact Information -

Central Service Rep (CSR) Name

CSR Email Address

CSR Phone

Alternate CSR Name

First Last

Alt CSR Email

Alt CSR Phone

Treasurer Name

First Last

Treasurer Email

Treasurer Phone

Treasurer Address (REQUIRED for groups with charge accounts, unless you prefer to receive emailed statements)

- Meeting Schedule Information -

Change Type(Required)

CHANGE Previously Submitted Information

DELETE Previously Submitted Information

ADD New Information Below

Meetings

Meeting Days	Time	Open/ Closed	Meeting Format/Type	Other (Please Describe)	Smoking	Actions

There are no Meetings.

To add meeting information changes to this submission, click the ADD MEETING button. Click ADD MEETING for each meeting you are wanting to submit changes for.

Additional Comments

Comments

This field is for validation purposes and should be left unchanged.

Northeast Central Service

Group Information Form (CHANGE)

- Submitter's Information -

- Group Information -

- Group Contact Information -

- Meeting Schedule Information -

Monday-Friday 9 am – 5 pm

Saturday 9 am – 1 pm

Northeast Central Service