NS Group Change Form

GROUP CHANGE FORM - Please provide the following:

Name of meeting as previously recorded (to locate correct entry): (*)

Day(s) of Week and time (hr:min am or pm) as previously recorded: (*)

Name of meeting, if changed:

Day(s) of Week and time, if changed:

Describe changes to name of facility, if any (from/to):

Describe changes to address, if any:

Describe other directions, if any (eg, use rear door):

Meeting type - select one if changed:

Meeting format- select one if changed:

Meeting info - other, if changed:

If changed - Handicapped accessible

If changed - Child Care Available

If changed - Smoking Permitted

Name of Group Secretary (new or confirm old) : (*)

Phone number for Group Secretary (*)

Email address of Group Secretary (or designee): (*)

Name of person submitting change: (*)

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Mansfield Area InterGroup

of Alcoholics Anonymous, Mansfield, Ohio