Please Complete and Submit the Form Below to Register a New Group If you are human, leave this field blank. Does your group meet in a hospital, treatment center, jail or other institutional setting? * Yes No If yes, is it open to regular AA members as well as patients or residents of the facility? * Yes No Group Name * Group Start Date * Group Meeting Location * Address * City/Town * Zip Code * Meeting Day(s) * Sunday Monday Tuesday Wednesday Thursday Friday Saturday check all that apply Meeting Type * C-Closed X-Step F-French Speaking S-Speaker B-Big Book H-Handicap Access &-Spanish Speaking D-Discussion G-Gay/Lesbian +-Hearing Impaired *-Al-Anon same time & Place check all that apply Start Time * 121234567891011 : 000510152025303540455055 AMPM End Time * 121234567891011 : 000510152025303540455055 AMPM General Service Representative (GSR) Name * Phone * Address * City/Town * State * Zip * Email * Alternate GSR or Mail Contact Name * Phone * Address * City/Town * State * Zip * Email * Eastern States Directory Ok to List in the Eastern States Directory for 12th Step Referral and/or requests for meeting information? * Yes No NOTE: If "Yes," the GSR's (or other contact) full name and telephone # will be included with the group's name and service number. Please type the characters displayed to prove you're human.