F-30 Alcoholics Anonymous New Group Form - A.a. Us And Canada
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G
F
LCOHOLICS
NONYMOUS
EW
ROUP
ORM
U.S. and Canada
“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 ive (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.
. .’s Traditions suggest that a group not be named after a facility or person (living or deceased), and
that the name of a group not imply affiliation with any sect, religion, organization or institution.
GROUP N ME: _________________________________________________________________
GROUP ST RT D TE: _____________________
GROUP MEETING LOC TION: ___________________________________________________
NUMBER OF MEMBERS: ____________________
DDRESS: _______________________________________________________________________________________________________________________________
CITY/TOWN: ______________________________________________
ST TE/PROVINCE: __________________________ ZIP CODE: ______________
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MEETING D Y
MON
TUES
WED
THURS
FRI
S T
SUN
MEETING TIMES
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___________
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Send correspondence from G.S.O. in ENGLISH
SP NISH
FRENCH
Meeting language (if different) _________________________
GENER L SERVICE REPRESENT TIVE
N ME: ____________________________________________________________
E-M IL: ________________________________________________
DDRESS: _________________________________________________________
CITY/TOWN: _________________________________________
ST TE/PROVINCE: _______________________________________
ZIP CODE: ____________________
TELEPHONE: _________________________
LTERN TE G.S.R.
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OR M IL CONT CT
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( Please check one
)
N ME: ____________________________________________________________
E-M IL: ________________________________________________
DDRESS: _________________________________________________________
CITY/TOWN: _________________________________________
ST TE/PROVINCE: _______________________________________
ZIP CODE: ____________________
TELEPHONE: _________________________
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Does your Group meet in a hospital, treatment center or detox center?
Yes
No
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If yes, is it open to
. . members in the community as well as to patients in the center?
Yes
No
G.S.O. publishes confidential
. . Directories for use by
. . members for Twelfth Step referral and/or meeting information. The
Directories include a group’s name and service number, and the full names and phone numbers of the contacts listed on this form.
Do you want your group listed in the Directory covering your region?
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Yes
No
SIGN TURE: _________________________________________________________________
D TE: ______________________
THREE W YS TO RETURN THIS FORM:
Postal Mail to:
. . World Services, Inc.
By Fax: 212-870-3003 ( ttn: Records)
E-mail:
Grand Central Station
P.O. Box 459
New York, NY 10163
FOR G.S.O. RECORDS DEPT. USE ONLY
DELEG TE RE NUMBER: _______________________
DISTRICT NUMBER:_______________________
GROUP SERVICE NUMBER ( SSIGN BY G.S.O.) _______________________
F-30 -
Revised 12-11
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