Electronic Registration Help

Adult Children of Alcoholics
World Service Organization

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Meeting Registration Information

ADULT 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
info@AdultChildren.org
adultchildren.org

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.

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.

Meeting Registration Information

MEETING REGISTRATION FORM

Help for filling out:

MEETING INFORMATION

Primary Contact Information

Secondary Contact Information or Meeting Mailing Address