ALCOHOLICS ANONYMOUS DISTRICT INFORMATION CHANGE FORM
Area 33	Effective Date:

Outgoing DCM (District Committee Member)
District:	Language of District:
^{(Please indicate District#)}	^English^Spanish^French

Name:
Address:
City:

State/Province:
ZIP/PostalCode:

Phone:

Hm.

Bus.

E-Mail:

Incoming DCM (District Committee Member)
District:	Language of District:
^{(Please indicate District#)}	^English^Spanish^French

Name:
Address:
City:

State/Province:
ZIP/PostalCode:

Phone:

Hm.

Bus.

E-Mail:

Outgoing DCMC (District Committee Member Chair)
District:	Language of District:
^{(Please indicate District#)}	^English^Spanish^French

Name:
Address:
City:

State/Province:
ZIP/PostalCode:

Phone:

Hm.

Bus.

E-Mail:

Incoming DCMC (District Committee Member Chair)
District:	Language of District:
^{(Please indicate District#)}	^English^Spanish^French

Name:
Address:
City:

State/Province:
ZIP/PostalCode:

Phone:

Hm.

Bus.

E-Mail:

Outgoing Alt. DCM (Alternate DCM)
District:	Language of District:
^{(Please indicate District#)}	^English^Spanish^French

Name:
Address:
City:

State/Province:
ZIP/PostalCode:

Phone:

Hm.

Bus.

E-Mail:

Incoming Alt. DCM (Alternate DCM)
District:	Language of District:
^{(Please indicate District#)}	^English^Spanish^French

Name:
Address:
City:

State/Province:
ZIP/PostalCode:

Phone:

Hm.

Bus.

E-Mail:

or mail to:

General Services of Southeastern Michigan
PO Box 2843, Southfield, MI 48037-2843