Abstinence-Oriented Support Group Meeting Attendance Record Form
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1Application for Reinstatement of a Revoked Nursing License – Alabama
Form 2
Abstinence-Oriented Support Group Meeting Attendance Record
Name: _________________________________
License #: __ - __ __ __ __ __ __
DATE
MEETING
TOPIC
NAME/TIME/LOCATION
VERIFY &
Example:
Example: Big Book
TYPE
OF MEETING
CONTACT
10/31/2014
Study, Faith, Shame,
Example: AA, NA,
Example: Lunchtime Reflections,
Example: LC, Meeting
Guest Speaker, etc.
Celebrate
12-1pm, Mobile, AL
Chairperson, 555-555-
Recovery, etc.
5555, Sponsor, etc.
Note: Use of this form is not required. However, use of it may prove to be good practice if the
license is reinstated, as record-keeping on Board-specific forms/formats is required upon
reinstatement.
Revised April 2015
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