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Meeting Change Request - JCCOAA & D16
(IMPORTANT: You do *not* need to have a google account to fill out this form -- you can bypass that part and go to "What is the name of your A.A. Meeting?")
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* Required
What is the name of the A.A. Meeting
*
Your answer
Please check the box(es) next to where you'd like to see this meeting change reflected?
*
Central Office Website (Jccoaa.org)
Printed Schedule (from Central Office or Self-Printed)
District 16 Website (
medfordareaaa.org
)
Meeting Guide App (app on your tablet/smartphone)
Required
Would you like to sign up for E-News Blasts?
Yes
No
Clear selection
Is this A.A. meeting New? Existing? Permanently Closed?
*
New meeting
Existing meeting
Permanently Closed (we will resubmit the meeting in the future if it ever starts up again)
Is this A.A. meeting currently (or soon to be) Online? In Person? Hybrid?
*
Online
In person
Hybrid (Online & In Person)
What is your A.A. Meeting location (ie name of church) AND what is the exact street address? (note: if your meeting is online, what are the tech details to attend your meeting?)
*
Your answer
What day(s) of the week does the A.A. Meeting meet?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Required
What time does the A.A. Meeting start?
*
Time
:
AM
PM
What time does the A.A. Meeting end?
*
Time
:
AM
PM
Is this A.A. meeting an Open Meeting? Closed Meeting
*
Open meeting
Closed meeting
Select the format that describes your Meeting
*
Discussion
Book Study
Speaker
Other
If your meeting is geared for a Specific Group, please choose an option below:
Men's Meeting
Women's Meeting
Other specific group
Clear selection
Is there anything else you'd like to let our local A.A. Schedule Coordinators know about this meeting to include in the listing? (i.e. if you selected "other" anywhere on this submission form , here is the place to tell us!)
Your answer
You are reporting this change to us because:
Your A.A. group conscience asked you to do so.
You're a good samaritan and are reporting to us as you heard it had changed.
Clear selection
What is your First Name?
*
Your answer
What is your Last Name?
Your answer
What is your email address?
*
Your answer
What is your Phone number?
Your answer
If we have a question, do you prefer that we reach out to you via
email
phone
Clear selection
Submit
Clear form
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