ALCOHOLICS ANONYMOUS NEW GROUP FORM
In accordance with AA’s Sixth Tradition, it is suggested that a group not be named after the facility in which it meets.
Does your group meet in a hospital, treatment center, jail or other institutional setting?
d Yes d NoIf yes, is it open to regular AA members as well as patients or residents of the facility?
d Yes d NoGROUP NAME:_________________________________________________________ GROUP START DATE: ______________________
GROUP MEETING LOCATION:______________________________________________________________________________________
ADDRESS: _______________________________________________________________________________________________________
CITY/TOWN:____________________________________________________________, NH ZIP:________________________________
MEETING DAY: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
(CIRCLE)
MEETING START TIME: ________________________ MEETING END TIME: ________________________
MEETING TYPE: __ C – Closed __ S – Speaker __ D - Discussion
(CHECK ALL THAT APPLY) __ X – Step __ B – Big Book __ G - Gay/Lesbian
__ N – Non-Smoking __ H – Handicap Access __ + - Hearing Impaired
__ F – French Speaking __ & - Spanish Speaking __ * - Al-Anon same time & place
GENERAL SERVICE REPRESENTATIVE (GSR)
NAME: ______________________________________________________________ TELEPHONE: (_______)_____________________
ADDRESS: ______________________________________________________________________________________________________
CITY/TOWN: ____________________________________________________ STATE: ________________ ZIP: ____________________
E-MAIL ADDRESS: ________________________________________________________________________________________________
ALTERNATE GSR or MAIL CONTACT
(circle one)NAME: _______________________________________________________________ TELEPHONE: (_______)_____________________
ADDRESS: _______________________________________________________________________________________________________
CITY/TOWN: _____________________________________________________ STATE: ______________ ZIP: ______________________
E-MAIL ADDRESS: ________________________________________________________________________________________________
The GSR’s (or other contact) full name and telephone number will be included with the group’s name and service number.
OK TO LIST IN THE DIRECTORY?
A YES A NO Groups without a phone listing will NOT be in directory.
Signature: _______________________________________________________________________________________________________
AREA 34 DISTRICT NUMBER: _____________________________________ NUMBER OF GROUP MEMBERS: _________________________________
"Our membership ought to include all who suffer from alcoholism. Hence we may refuse none who wish to recover. Nor ought AA Membership ever depend upon money or conformity. Any two or three alcoholics gathered together for sobriety may call themselves an AA group, provided that, as a group they have no other affiliation." – Tradition Three (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 Five (long form)
"Unless there is approximate conformity to AA’s Twelve Traditions, the group … can deteriorate and die." – 12 & 12, page 174