Your Name

    Your Phone Number:

    Your Email:

    Meeting Type

    Group Name*

    Preferred Meeting Day(s) and Time(s)*

    Desired Start Date

    Estimated Number of People*

    Preferred Meeting Space

    Meeting Type (Check all that apply)

    Group Founding Members

    Member 1

    Name*

    Email*

    Cell phone*

    Member 2

    Name*

    Email*

    Cell phone*

    Member 3

    Name

    Email

    Cell phone

    Member 4

    Name

    Email

    Cell phone

    Use this space to provide the Board with any additional information about your meeting.

    Affirmation statement & signature
    I agree that all individuals noted above as “founding members” meet the minimum 1-year AA/Alanon/Alateen requirements as stated on page 1 of this application and have agreed to commit to holding this meeting for at least 6 months if our application is approved and for paying the Club rental fee of 75% of each 7th tradition basket.