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Families Anonymous Existing Group Changes

Group#*

Effective Date*

Section 1: Select All That Apply*

Meeting ChangeSecretary ChangeGroup Closed

If your group is closing, please skip to section 4.

Section 2: Meeting Information

Please only enter information that requires change.

Country

State/Province

City

Zip/Postal Code

Facility Name

Address

Meeting Instructions

Average Weekly Attendance

Meeting Day(s)

Meeting Start Time

Meeting End Time

Group Contact Phone 1

Phone 2 (Optional)

Group Web Site (Optional)

Group Contact eMail Address

Section 3: Group Secretary Information

Please only enter information that requires change.

Full Name

Street Address

City

State/Province

Zip Code

Secretary Phone 1

Phone 2 (optional)

Secretary eMail Address

Section 4: Questions/Comments

Questions/Comments

Section 5: Group Secretary Signature

By Signing your name below, you are giving Families Anonymous (FA) permission to use the Group Contact e-mail address and Group Contact Phone # on the FA website.

Signature*

eMail Address*

Date*

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Families Anonymous Existing Group Changes

Section 1: Select All That Apply*

Section 2: Meeting Information

Section 3: Group Secretary Information

Section 4: Questions/Comments

Section 5: Group Secretary Signature

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