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FAMILIES ANONYMOUS, INC. |
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This service is for the convenience of FA group
secretaries. |
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| NOTE: The * symbol indicates fields that are required. Please complete all entries before submitting this form. | |||||||||||||||||||
| MEETING INFORMATION: Used for meeting directories- Printed and Website. | |||||||||||||||||||
| Group Number * | PLEASE ENTER "NEW" IF YOU ARE A NEW GROUP REGISTERING FOR THE FIRST TIME. | ||||||||||||||||||
| Country * | |||||||||||||||||||
| State/Province * | |||||||||||||||||||
| County * | |||||||||||||||||||
| City * | |||||||||||||||||||
| Location or * Facility Name | |||||||||||||||||||
| Street Address * | |||||||||||||||||||
| Building/Room, Specific Directions or Parking Information | |||||||||||||||||||
| Meeting Day(s) * | |||||||||||||||||||
| Meeting Time(s) * | AM or PM? * | ||||||||||||||||||
| Group Contact * Phone Number(s) |
Is this a cell phone? * (Contact phone numbers appear on WSO directories and should NOT be the number of the meeting place.) |
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| Group Email Contact |
(Contact phone number and contact email may be the phone number and/or email address of the secretary or any member of the group.) |
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Permission to use |
FA has my permission to
use; (mark an "X" in each field where permission is given) the Contact Email address and/or the Contact phone number on the FA website. Type your "Signature" below to give permission. |
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| Signature
* (type your name) |
Type "NO" in the signature space if you do not give permission to use either forms of contact information above on the FA website. |
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| SECRETARY INFORMATION: Used for mailing labels and contact.. | |||||||||||||||||||
| First Name * | |||||||||||||||||||
| Last Name * | |||||||||||||||||||
| Street Address * | |||||||||||||||||||
| City * | |||||||||||||||||||
| State/Province * | |||||||||||||||||||
| Country | |||||||||||||||||||
| ZIP/Postal Code * | |||||||||||||||||||
| Home Phone # * | |||||||||||||||||||
| Work Phone # | |||||||||||||||||||
| FAX # | |||||||||||||||||||
| Email Address | |||||||||||||||||||
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