Please print, complete and return by mail or fax (see below). CONFIDENTIAL – Full names of AA member can be used.
Cleveland District Office #		General Service # (if known):
Prepared by:		Date:

Group History
Name of Group:
Previous Name(s) if any:
Date Founded:
Founder(s):
Early Members:
Place and time of first meeting:
Current location (moved?):
History (anniversaries, special meetings, outside speakers, notes about founders, etc…)
Use more paper if necessary.

Return by mail or fax:
Mail: AA Cleveland District Office, 1557 ST. CLAIR AVE NE, Cleveland, OH 44114-3236
Fax: 216-241-5350