District 4 New Group Registration Form

Please use this form if your group is interested in registering with the General Service Office and receiving a group number. Filling out this form will result in your group being entered in the South Florida Area 15 registrar database as well as in Fellowship Connection, the General Service Office’s database, which will connect your group for communication purposes to your district, to South Florida Area 15, and to the General Service Office.

PLEASE NOTE: This form will NOT add your group to your local meeting list, nor will it add your group to the online Meeting App. Please contact your Intergroup or Central Office for information on how to do that.

Submitting this form will send the information to both the District 4 and Area 15 Registrars.

All  Required* fields must be completed for your district registrar to process this form for your group.

>>> Group Name *

A.A.’s Traditions suggest that a group not be named after a facility or member (living or deceased), and that the name of a group not imply affiliation with any sect, religion, organization or institution.

Group Start Date *

Group Type *

• In Person only
• Online only
• Hybrid/unified

Group Location (name of Church, Park, etc.) *

Group Street Address (if the meeting is in a physical location) *

Group City, State, Zip Code *

Number of Group Members *

Group Language *

• English
• Spanish
• French

>>> Your group’s General Service Representative (GSR) - GSR's Name

GSR's Street Address (regardless of whether the group meets in person or virtually)

GSR's City, State, Zip Code

GSR's Telephone Number

GRS's Email Address

Does GSR want to receive a GSR kit from GSO?

• Yes
• No

If so, does GSR want a digital kit or a hard-copy kit?

• Digital
• Hard Copy

Does GSR want to receive District agendas/minutes?

• Yes
• No

Does GSR want to receive Area 15 agendas/minutes?

• Yes
• No

>>> Your group’s Alternate General Service Representative (AGSR) - AGSR’s Name

AGSR’s street address (regardless of whether the group meets in person or virtually)

AGSR’s City, State, ZIP Code

AGSR’s Telephone Number

AGSR’s Email Address

Does AGSR want to receive District agendas/minutes?

• Yes
• No

Does AGSR want to receive Area 15 agendas/minutes?

• Yes
• No

>>> If your group has neither a GSR nor an Alternate GSR, please list a group contact for your group: Contact name

Contact’s street address (regardless of whether the group meets in person or virtually)

Contact’s City, State, ZIP Code

Contact’s Telephone Number

Contact’s Email Address

Does group contact want to receive District agendas/minutes?

• Yes
• No

Does group contact want to receive Area 15 agendas/minutes?

• Yes
• No

>>> Submitted by: Name *

>>> Submitted by: Email *

>>> Submitted Date: *

>>> Submitted by Telephone Number: *

In case the Registrar has any questions. Thank You!

Submit to District 4 Registrar