If your group is re-registering, only input information that has changed from the previous year.

If no changes are made, we require only your group number, effective date, your electronic signature and today's date on the form.

* Indicates a required field

Families Anonymous Existing Group Re-Registration

Group#*

Effective Date*

Section 1: Select All That Apply*

Annual Re-registrationMeeting ChangeSecretary ChangeGroup Closed

Section 2: Meeting Information

Please only enter information that requires change. If you have no changes in your meeting or secretary information, skip to Section 4.

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

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 Re-Registration

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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