Request Form for a Registered (has a Group ID) Permanent Electronic Group(PEG) to join Area 25 (MA)CURRENT MAILING ADDRESS (CMA)WSO mail for the group is sent to the postal and email addressesCMA First NameCMA Last NameCMA Email AddressCMA Phone #CMA Street/PO BoxCMA City/TownCMA State/ProvinceCMA Zip/Postal CodeCMA CountryBest way to contactemail, text, phone, …?Is the CMA also the Group Representative (GR) for this meeting?YesNo, there is another member serving as GRNo, but we do not have a GR at this time.GROUP REPRESENTATIVE (GR) if availableMembers of Al Anon who are also members of AA do not serve as Group Representatives. “Members honor this policy out of respect for Al Anon unity and the group conscience process, in accordance with Tradition One and Tradition Two.” (see 2022-2025 Al-Anon/Alateen Service manual, page 87)GR First NameGR Last NameGR Email AddressGR Phone #GR Street/PO BoxGR City/TownGR State/ProvinceGR Zip/Postal CodeGR CountryBest way to contactemail, text, phone, …?Group NameGroup ID#:SPECIAL GROUP FOCUSAlthough everyone is welcome at an Al-Anon meeting, some meetings have a special focus.Does your group have a special focus? (check all that apply)No Special FocusParents of AlcoholicsAdult ChildrenWomenMenLGBTQIA+People of ColorYoung AdultsNon-English Speaking (e.g. Spanish, Portuguese, ASL)What language?OTHER GROUP DETAILS (Check all that apply)Family and Friends Only (Closed meeting)Beginners meeting offeredStep MeetingASL interpreterPlease specify any other special meeting focus.WHAT DAY(s) DOES YOUR GROUP MEET?What day(s) does your group meet? (Check all that apply)SunMonTuesWedThursFriSatWhat time does your meeting begin on SUNDAY?HoursMinutesAMPMWhat time does your meeting begin on MONDAYS?HoursMinutesAMPMWhat time does your meeting begin on TUESDAY?HoursMinutesAMPMWhat time does your meeting begin on WEDNESDAY?HoursMinutesAMPMWhat time does your meeting begin on THURSDAY?HoursMinutesAMPMWhat time does your meeting begin on FRIDAY?HoursMinutesAMPMWhat time does your meeting begin on SATURDAY?HoursMinutesAMPMInformation to help determine which district to place your group.Was this Group an in-person MA meeting at one time?NoYesWhen this was an in-person group, what was the Town, Day(s), and start time of the meeting?SUBMITTED BY:NameEmail AddressPhoneBest Way to ContactPhone, text, email, …SUBMIT FORM
