U.S. and Canada
Alcoholics Anonymous Group 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 Group Service Number: Date
Group Start Date: Number of Members:

Old Group Information New Group Information
Group Name:
Location: Location:
Street: Street:
City/St/Zip: City/St/Zip:
Phone: Phone:

Meeting Day and Time

Meeting
Day		 SUN MON TUE WED THU FRI SAT
Meeting
Time
Type of
Meeting
LANGUAGE:
(check one)		 ENGLISH SPANISH FRENCH OTHER

Old General Service Rep (GSR) New General Service Rep (GSR)
Name: Name:
Street: Street:
City/St/Zip: City/St/Zip:
Phone: Phone:
Email: Email:
OK to list in A.A. Regional Directory? Yes   No
Receive Area 14 Minutes by:  Email    USPS

If the Group is to be listed in the Directory, please provide a telephone number and mailing address for the GSR, Alternate GSR or Group Mail Contact. Listing in the Directory is for Twelfth Step referral and/or for meeting information. The GSR’s (or other contact) name and telephone number will be included in the Directory with the group’s name and group service number.
Old Alt. GSR
or Old Mail Contact 		New Alt. GSR
or New Mail Contact
Name: Name:
Street: Street:
City/St/Zip: City/St/Zip:
Phone: Phone:
Email: Email:
OK to list in A.A. Regional Directory? Yes   No
Receive Area 14 Minutes by:  Email    USPS
Signature:   Date:
Service Position:   Phone: