RSA & RSC Sign-In Form

Use this form the day of the meeting to affirm your attendance at Regional Assemblies and Area Service Committee meetings. This information is sent to the Regional Secretary and will be kept confidential within the Regional Service Committee.

First Name & Last Initial

First Name

Last Name

Phone

(###)

###

####

Radio

Group Service Representative (GSR)

Alternate GSR

Substitute GSR

RSC Member

Observing Member

Other

Group Name

Group City

Group Day(s)

Group Meeting Time (PT)