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Alcoholics Anonymous Ireland
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NEWLY ELECTED GSBAA COMPANY MEMBER / CONFERENCE DELEGATE FORM
Service Position
(Required)
Company Member / Conference Delegate
Company Member / Intergroup Secretary
Company Member / World Service Delegate
Provincial Intergroup
(Required)
Leinster Intergroup
Munster Intergroup
Connaught Intergroup
Ulster Intergroup
WSD's should select the Intergroup they represented as Company Member / Conference Delegate
Term Start Date
(Required)
MM slash DD slash YYYY
Term Finish Date
MM slash DD slash YYYY
Contact Name
(Required)
First
Last
Full Postal Address
(Required)
Address Line 1
Address Line 2
Town / City
County
Eircode / Postcode
Mobile No.
(Required)
Please notify the Company Secretary ASAP if there are changes to your contact details during your term. GSO will contact you with the AA Mailbox username and password.
Name of the Company Member being replaced
(Required)
First
Last
Name of the AA Trustee approving the details
(Required)
First
Last
Date Form Submitted
(Required)
MM slash DD slash YYYY
Consent
(Required)
I understand that by clicking the submit button, I am consenting that all information provided in the form can be used in line with the GSBAA Privacy Statement, available at
www.alcoholicsanonymous.ie
. A copy of the submitted form will also be forwarded to the Board Secretary's mailbox.
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