Nomination for Queens Area Rep – New York Inter-Group

Nomination*
- I nominate myself for the position
- I nominate someone else for the position
Contact information of person submitting the nomination
Name*
First Last
Phone*
Email*
Person nominated
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Home Group*
Sobriety Date*
Month
Day
Year
I believe myself/this A.A. member an appropriate candidate because of the following
Home Group service experience*
New York Inter-Group experience*
Other A.A. General Service experience*
Additional Qualifications*

Contact information of person submitting the nomination