New General Service Representative Form

If any issues or questions, please email the District 08 Registrar at registrardistrict08@gmail.com

First Name

Last Name

AA is an anonymous program, we will use this information only to keep our data organized and it will not be shared outside of AA.

Phone

Use format (123) 456-7890

Your Street Address

(not your group's address)

City

State

ZIP

Use format 12345

Service Position

Group Name

Old GSR Name

(If Known)

Old Alt. GSR Name

(If Known)

Comments

Please enter group name if you couldn't find it on the list. And let us know if any issues with your submission or information we may find useful

Do not submit passwords through this form. Report malicious form