Group Forms – St Augustine AA • District 6

Group Name

Street Address

Landmark/Church

Zip Code

Group Start Date

Est. Number of Members

Meeting Day(s)

Meeting Time

Meeting Type

Language

English Other

GSO/WSO Number

General Service Representative

GSR Digital Signature

GSR E-mail

GSR Address

GSR Phone Number

GSR Zip

Alt GSR

Alt GSR E-mail

Alt GSR Address

Alt GSR Phone

Alt GSR Zip

Does your group meet in a hospital, treatment center, or detox center?

Yes No

If yes, is it open to A.A. members in the community as well as patients in the center?

Yes No

OK to list in the directory?

Yes No

Today's Date