Name:                                                                         Zip Code:                          

Sobriety Date:                                             Weekday Phone:                                      

Checkmark   :   ___ Male   ___ Female       Other Phone:                                      

Please indicate what A.A. Service commitments you are willing to volunteer:

 

___ 12^th Step**                                     ___ After-hour telephone answering  

___ Central Office volunteer           ___ Speaking at other A.A. meetings

**12^th Step involves being asked to talk to a member or relapser or new person who has reached out for A.A.’s help to attain or maintain sobriety; sometimes to actually visit but NEVER GO ALONE!

Please checkmark days/times you are usually available for the above:

 

More service commitments:

___ Young People in A.A.                     ___ S.R.I. Special Event Service Committee

___ Hospitals & Institutions                   ___ Bridge the Gap

___“The Filing Cabinet” Newsletter    ___ Public Info / Cooperation with the

                                                                                Professional Community

 

By initialing, I acknowledge that I understand this information will be distributed to service committee members by e-mail, as needed:

 

                                                            Initials:                      Date: