U.S. and Canada
Alcoholics Anonymous District Information Change Form
 

To be forwarded to Area 14 Registrar to make updates to General Service Office records
Please provide as much information as possible
Area 14 District Service Number Date
District Language of District ENGLISH      SPANISH        FRENCH

Outgoing DCM
(District Committee Member)		 Incoming DCM
(District Committee Member)
Name: Name:
Street: Street:
City/St/Zip: City/St/Zip:
Phone: Phone:
Email: Email:
Receive Area 14 Minutes by:  Email    USPS

Outgoing Alt. DCM
(Alternate District Committee Member)		 Incoming Alt. DCM
(Alternate District Committee Member)
Name: Name:
Street: Street:
City/St/Zip: City/St/Zip:
Phone: Phone:
Email: Email:
Receive Area 14 Minutes by:  Email    USPS
Name of Committee:

Outgoing District
Committee Chair		 Incoming District
Committee Chair
Name: Name:
Street: Street:
City/St/Zip: City/St/Zip:
Phone: Phone:
Email: Email:
Receive Area 14 Minutes by:  Email    USPS
Signature:   Date:
Service position: Phone: