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New Group Form

NEW GROUP REGISTRATION FORM
If this group has been registered previously, please use the"Group Update Form"
Please note that fields with an asterisk *will require the appropriate information filled in! 

   
*Your Name:
(First and Last)
*Your Email:
*Group Name:
This Group was formed?
(Month/Year)
This group holds how many
meetings per week?
Area Service Committee Name
(Use full name, no initials please):
*Regional Service Committee Name
(Use full name, no initials please):
   


Group Contact Mailing Address
This is typically a stable group member who can forward any communication from NA World Services to the NA group. This may or may not be a current group trusted servant, and is not usually the group's meeting location address.

 
   
*Group Contact:
(First and Last Name)
*Email:
*Address:
*City:
*State/Province
*Postal/Zip
*Country:
Phone:


Group's Meeting Information
Please indicate whether meeting is open or closed. Also check what day(s) the meetings are held.
Day of Week Sun
Mon
Tues
Wed
Thur
Fri
Sat  
Is Meeting Open or Closed?*
Open

Closed

Open

Closed

Open

Closed

Open

Closed

Open

Closed

Open

Closed

Open

Closed

Meeting Time 
Language(s) 
WC Accessible 
Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

  Room Name

*Open NA meetings welcome addicts and interested observers; Closed NA meetings welcome addicts only.


Date Meeting Format Meeting Information
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday


Meeting Location
 

*Place:
 
 
*Address:
*City:
Borough:
*State/Providence
*Zip/Postal
*Country:
   

If this meeting is held in a correctional or treatment facility, are there special criteria for entry?



Additional Information

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Please copy the letters or numbers above prior to hitting Submit

If you have any questions or concerns that are not related to this group's registration, please contact info@na.org

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