Bay Cities Area of Narcotics Anonymous

Meeting Change Form

Current Date: Wednesday, September 08, 2010
   
This Change Form is for a:   New Meeting
    Meeting Update
    Meeting No Longer Exists

Old Meeting Information (Only for Meeting Update or Meeting No Longer Exists)

Day (please check)

Mon

Tue

Wed

Thur

Fri

Sat

Sun
Time
  AM       PM
Name
Address
City

New Meeting Information (Only New Meeting or for Meeting Update)

Day (please check)

Mon

Tue

Wed

Thur

Fri

Sat

Sun
Time
  AM       PM
Name
Address
City
Language English           Spanish         Other
Restrictions?   No       Yes     ((e.g., clean time or dress code requirement)
Type
 
(check all that
 
 
 
 
 
 
 
 
   Open    Participation
   Closed for Addicts Only    Question & Answer
   Basic Text Study    Rotating Format
   Candlelight    Smoking
   Gay/Lesbian    Speaker
   It Works How & Why    Step Study
   Just for Today    Tag Topic
   Child Care    Topic Meeting
   Children OK    Tradition Study
   "Men's Stag"    Wheel Chair Access
   Non Smoking    "Women's Stag"
   Outdoors    "Young People's Meeting"

Contact Information (GSR)

Name
Phone Number
Email Address

For Website Committee Use Only

Date Received  
Updated in Area Database (Date & Initial)  
Updated in Regional Database (Date & Initial