Test Group Information – MA Al-Anon & Alateen

Meeting registration WSO ID# *ID# is on MA Website Meeting List

Meeting Day, Time, Town listed on MA Website *

Please fill in GR (Group Rep) contact information

Does this group have a GR?YesNo

GR NameGroup Rep Name

GR PhoneGroup Rep Name

GR Email AddressCMA is Current Group Contact if no GR

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

CMA (Current Mailing Address contact for WSO mailings)

Is the GR also the CMA (Current Mailing Address and group contact)?YesNo

CMA NameCMA (Current Mailing Address and group contact) to receive mailing from WSO

CMA Phone NumberCMA (Current Mailing Address and group contact) to receive mailing from WSO

CMA Email AddressCMA (Current Mailing Address and group contact) to receive mailing from WSO

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Group phone number and/or email to share with publicIf this group has a phone number or email for meeting access, please provide information.

Does this group have a group phone and/or group email?YesNoThe group email is shared with the public trying to contact this group. Not all meeting have this.

First Name

Group Phone NumberLeave Blank if the group does not have an email address

Group Email AddressLeave blank if the group doesn’t have an email address

Meeting Name *E.g., One Day at a Time has become Keep it Simple

Meeting Town *For a District 25 meeting enter “Monroe”

Request district change *Note: District change needs to be approved by outgoing and incoming districts

Meeting Start Time *Make sure to include AM or PM

Meeting End Time *Make sure to include AM or PM

How is your group meeting? *IN-PersonVirtual (video like Zoom and/or dial-in)Both In-Person and Virtual

In-Person meeting Information

Location of meeting *

Address of meeting *

SpeciaI instructions for attending meeting (e.g., which door to enter, …)

Online Meeting Information

What is the virtual meeting I.D.E.g., Zoom or Conference call ID or you can add an email contact to get meeting access. Please, no emails containing first and last names please.

What is the virtual meeting password?or write “no password”

What is the dial-in number?

What is the link to the meeting?You can also write “none”

Would you like to join the Shared Virtual (Zoom) Account?YesNoOur group has already joinedMA Al-Anon Groups can pay annually for a weekly slot on our Zoom Account.

Who is submitting this form?

Name

Phone

Role of Person Submitting FormGRCMA (Group Contact)DRDesignated by group to submit this form

Email Address

Any comments or questions?if you group is meeting more than 1 day a week, enter the other days and times here.