Group Information Form (NEW)

IMPORTANT: Use this form for reporting a new group. New groups will also want to submit 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 change information on an existing 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)

Start Date(Required)

When does this group start meeting?

Group Address (For Zoom Only meetings, type N/A in the street address but fill out City, State, & Zip)(Required)

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

Location Information(Required)

For example: "Episcopal Church" or "Use South door." (If no location information needs to be submitted, simply put "N/A" in this field.) If ZOOM ONLY, meeting ID and password MUST be listed here.

- Group Contact Information -

Primary Contact Name(Required)

Primary Contact Email Address(Required)

Primary Contact Phone(Required)

Alternate Contact or CSR Name

First Last

Alt Contact or CSR Email

Alt Contact or CSR Phone

The Contact Above is the:

Alternate Contact

Central Service Representative

Check only if you added a second contact person

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 -

Meetings

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

There are no Meetings.

Add each INDIVIDUAL meeting SEPARATELY. To add information (date/time, etc.) to this submission, click the ADD MEETING button. Click the ADD MEETING button for EACH meeting (date/time, etc.) you are wanting to submit. ALL FIELDS ARE REQUIRED or we cannot add your group!

Additional Comments

Name

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

Northeast Central Service

Group Information Form (NEW)

- 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