ACA Meeting Entry Form

Adult Children of Alcoholics
World Service Organization, Inc.

Meeting Registration


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Note: In order for the ACA WSO to be of maximum service the following information must be current, accurate and complete. All information on this form will be used for ACA service purposes only.

Use of this on-line form requires entry of an e-mail address in the Primary Contact Information area of the form. If you prefer to not provide this information to the WSO (anonymity), please use the paper Registration Form instead. Click here to download a copy of this form.

WSO meeting number: (existing meetings only)

Meeting Start Date: (if known)

Meeting Group Name: (optional)

Check here if Registering for the first time.
Check here if submitting an Information Update Only.
Check here if submitting a meeting cancellation notice.
Don't know your WSO meeting number? Then click here to go to the ACA meeting list. When you find your meeting, you'll find the WSO meeting number in parenthesis near the end of your meeting's description.

MEETING INFORMATION

Country:

Address:

City:	County:
State/Province:	Zip Code:
Day of week:	Meeting Time:

Any additional information on how to find the meeting:

(Cross streets, Buildings, Church, etc.)

Meeting Type (check all that apply):

Male Only	Female Only	Gay/Lesbian
Beginners	Open to All	ACAs Only (Closed)
Other (please specify):

Meeting Focus (check all that apply):

Discussion	Speaker	Steps
Book Study	Fellowship Text	Workshop
Other (please specify):

Other Notes (again, check all that apply):

Smoking	Wheelchair Access	Child Care Available
Non-smoking	Needs Support
Other (please specify): Language: Other Comments or Info:

Intergroup Affiliation:(leave blank if not part of an Intergroup)

Intergroup Name:

Phone:

PUBLIC CONTACT INFORMATION: Please supply us with the following information to be used to assist people in finding your meeting, or to answer questions they may have about attending your meeting. Note: The WSO will provide the information in this section to anyone searching for a meeting in your area. Do not put any information in this section that you want kept private. If you want to preserve total anonymity, you may leave this section blank.

Phone contact name: (first name or nickname is suggested)	Phone Number:
E-mail contact name:	E-mail address:

PRIMARY CONTACT INFORMATION: Please provide your full name and address in this section to allow us to contact you personally if needed. The information in this section will be for use only within the ACA service structure, will be kept confidential and will not be available thru the public web site. Starred fields must be filled in. See note at top of form if you are unwilling to complete this section.
Each meeting must have at least one contact person on record with his/her own mailing address.

First Name: Last Name:	Position in meeting:
*Street/P.O.Box:
*City:	State/Province: Zip Code:
Phone Number: Alternate Phone Number:	*E-mail address: Please verify the accuracy of this e-mail address. It will be used to send you a confirmation notice of your ACA meeting submission.

SECONDARY CONTACT INFORMATION (optional): In case we cannot reach the Primary Contact Person, we also ask for a Secondary Contact Person to be identified where possible. The information in this section will be for use only within the ACA service structure, will be kept confidential and will not be available thru the public web site.

First Name: Last Name:	Position in meeting:
Street/P.O.Box:
City:	State/Province: Zip Code:
Phone Number: Alternate Phone Number:	Personal E-mail address:

In submitting this form, you are certifying that you are authorized to act on behalf of this ACA meeting and that all the information provided is correct to the best of your knowledge.