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A DULT CHILDREN OF ALCOHOLICS
WORLD SERVICE ORGANIZATION
MEETING REGISTRATION FORM
(Check www.adultchildren.org
for help in filling out this form.)
(If printing out, try selecting a small font.)
(For best printing, we suggest using the Adobe
Acrobat version on our web.) |
P.O. Box 3216
Torrance, CA 90510
(310) 534-1815
ACA WSO |
HELP WITH THE MEETING REGISTRATION FORM
Help for filling out:
|
Comments on how to better complete this form are
provided in blue (this color). |
Date ___/___/___ First time Registering [ ] Start Date ___/___/___ Information Update [
] WSO Meeting # _____
| First time Registering or Information Update: |
If meeting has never registered, pick "First
time", otherwise check "Information Update". |
| Start Date (Date a meeting
started) |
Helps people find or support new meetings, or find out meetings
that have been around for a while. If not known exactly, please enter your best
guestimate. Please use the form MM/DD/YYYY Example: 01/30/1998 |
| WSO Meeting #: |
can be gotten from the web if it's an existing meeting,
otherwise leave blank (if new meeting). |
Please Note: In order for ACA WSO to be of
maximum service the following information must be current, accurate and complete.
All personal information on this form is confidential and will be used for ACA service
purposes only. |
MEETING INFORMATION
Country______________________________
City _____________________________ County ________________State ___________________ Zip
____________
Day ____________Time ______am[ ] pm[ ] Group
Name________________________________________________
Group Name |
Enter your group's name i.e. Serenity, Discovery, Inner Peace
etc.
If your group does not have a name you may wish to choose
one or call
it after your town or meeting day.
Example: Huntsville Group, Monday Night Group |
Address: ________________________________________________________(Can receive mail
here? NO[ ] YES[ ] )
| Street Address |
The actual municipal street address in full Example:
462 St. Clair Ave. West
(Avoid P.O. Box Numbers) |
Specific Meeting Location
_________________________________________________________________________
| Location |
The name of the building, church or institution where the
meeting is held. |
(Cross Streets, Building, Church, etc. For Example: Upstairs in back room in
church at Allen @ Del Mar)
Type- M[ ] F[ ] Gay[ ] Lesbian[ ] Beginners[ ]
Other__________________________Open To All[ ] Closed (ACA's only)[ ]
|
Select one or more above for male, female, ... |
Newcomers Meeting (or Beginners meeting) |
A special meeting to introduce those interested in learning
about ACA. Usually a speaker, sometimes no general sharing, introduction meeting. |
Closed |
Meeting is closed to the general public. Sometimes restricted to
those who consider themselves with ACA characteristics. Sometimes closed may also be in
regards to penal institutions. Most meetings are Open. |
Focus- Discussion[ ] Speaker[ ] Steps[ ] Book Study[ ] Other
__________________________________________________
| |
Select one or more above |
| Discussion |
A topic for general discussion is introduced. General sharing
may be allowed. |
| Speaker |
A guest speaker relates his/her story. General sharing may
occur before/after speaker. |
| Steps |
Focuses on sharing views on the 12 Steps and how they affect and
help us |
| Book Study |
Meeting focuses on one or more books. May be a smaller group,
meeting for a limited time, to study The 12 Steps or other material. Sometimes becomes
'closed' after first few initial meetings. |
Notes- Smoking[ ] Wheel Chair Access[ ] Child Care[ ] Needs Support[ ]
Other_____________________________________
Smoking |
Please select only if smoking is allowed at the meeting.
Note: It may or may not be permitted on the premises. |
Wheelchair
Access |
Please select only if FULL (including washrooms)
facilities are accessible. |
Child Care |
Select if a member of your meeting or facility where meeting
occurs
provides supervised child care. |
Needs Support |
Select if your meeting is small and/or would like more members
to attend to help make meeting costs. This will be valid for one year unless you
update your meeting information sooner. |
Language
_________________________Other Comments or Info
______________________________________________
Is the meeting affiliated with an Intergroup? Yes[ ] No[ ] Intergroup Name
__________________ Phone_________
Public Contact: Please give us the following meeting
information for our database and web site, to help find you.
Contacts--first name and initial _______________________ Phone ________________________
E-mail ________________
Contacts--first name and initial _______________________ Phone ________________________
E-mail ________________
The following Info is for ACA service work and will be kept Confidential:
We need to stay in contact with your meeting.
| Each Meeting should have at least one contact person with a mailing
address. |
Primary Contact Information
Position at meeting _____________________________ Last Name _________________First Name
________________
Street / P.O. Box
___________________________________________________________________________________
City ______________________________________State ____________________________
Zip___________________
Home Phone ( ) _______________ Alternate Phone ( ) ________________ e-mail
________________________
Secondary Contact Information or Meeting Mailing Address
Position at meeting _____________________________ Last Name _________________First Name
________________
Street / P.O. Box
___________________________________________________________________________________
City ______________________________________State ____________________________
Zip___________________
Home Phone ( ) _______________ Alternate Phone ( ) ________________ e-mail
________________________
Please list additional information on back. |
990107 |
|
Mission
ACA is