Register a New Meeting What is the meeting's name?*Do you have a group number?NoYes*Provided by General Service OfficeWhat is the Group Number?When was the group formed?Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What is the name of the building or location where they meet?What is the street address where they meet?*Where is the meeting located?*please select region from listAlturasAuburndaleAvon ParkBabson ParkBartowDavenportFort MeadeHaines CityIndian Lake EstatesLake AlfredLake PlacidLake WalesLakelandMulberryPolk CitySebringWahnetaWauchulaWinter HavenZolfo SpringsWhat day(s) of the week do they meet?*select at least one below Sunday Monday Tuesday Wednesday Thursday Friday Saturday What time does the meeting start?* HH : MM AM PM What type of meeting is it?Who will serve as the group's Intergroup Representative?Information will be kept confidentialName* First Last Initial Email* Phone*Mailing Address Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Alternate Contact Information (Optional)From time to time, Heartland Intergroup may need to get in touch with your group regarding announcements or other official business. Some groups prefer to use a group mailing address, email address, or phone number on file that is separate from the Intergroup Representative. If your group would like to use alternate information, please provide that below.Group Mailing Address Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Secondary Email Secondary PhoneIs there anything else that you feel is important to know about this meeting?
