Nar-Anon Central California Region
Group Service Representative (GSR) and Alternate GSR Registration Form

The area or group submits the following name to the region for acknowledgement as an authorized GSR or Alternate GSR for registration with the region. This information is sent to the Regional Secretary and will be kept confidential within the Regional Service Committee.

Current Trusted Servant Information

Position

GSR

Alternate GSR

Substitute GSR

Service Start Date

YYYY

Name

Please enter your first name and last initial.

First Name

Last Name

Phone

(###)

###

####

Skype Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Group Name

City (or Virtual)

Meeting Day(s)

Meeting Time (PT)

Group ID

Nar-Anon Central California RegionGroup Service Representative (GSR) and Alternate GSR Registration Form

Current Trusted Servant Information

Nar-Anon Central California Region
Group Service Representative (GSR) and Alternate GSR Registration Form