New Group Form

Please Complete and Submit the Form Below to Register a New Group

Does your group meet in a hospital, treatment center, jail or other institutional setting? (required)

If yes, is it open to regular AA members as well as patients or residents of the facility? (required)

Group Name (required)

Group Meeting Location (required)

Group Start Date (required)

Address (required)

City/Town (required)

Zip Code (required)

Meeting Days (required)

Meeting Type (required)

Start Time

End Time

General Service Representative

Name

Phone

Address

City/Town

State

Zip

Email

Alternate GSR or Contact

Name

Phone

Address

City/Town

State

Zip

Email