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NA India Meeting List Update/Modification Submission Form

Please fill / select appropriate info as listed below. * indicates that these field are required.

Date Of Submission *
   [E.g. DD MM YY]
 
Name Of NA Area/Region *
 
 
Name Of Group *
 
 
Meeting Place Address *
 
 
City Name *
 
 
State Name *
 
 
Pin Code *
 
 
Meeting Days
Mon Tue Wed Thru Fri Sat Sun
 
Meeting Start Timing *
   [Use 24 hours clock e.g. 09:00 or 11:30 or 19:30]
 
Meeting Type/Format
Open Closed Sharing Discussion/Reading Q & A Women's Only Handicap Support  Non Smoking
 
Meeting Language
Hindi Local Language English
 
Name Of Trusted Member Requesting Addition/Modification *
 
 
Area Contact Phone Number
 
 
Area Contact Email *
 
 
Additional Information [such as your areas website URL e.g. www.naindia.org or additional phone/email contact or if a group has  meetings multiple time in a week with different meeting format/type, please mention.]
 
 

Last Updated On 17 Jul 2007 07:43:25 PM
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