Welcome to Co-Dependents Anonymous
The CoDA World Fellowship

CoDA Group Registration Form The completion and return of this form to CoDA will register your meeting. Your meeting will be assigned a number and be registered in our meeting directory. Group Name: __________________________________ Group Meeting Place: ___________________________ Street Address: __________________________________________________________________________________ City: ________________________________________  County: ______________________________________ State: _________________________________ Zip: _______ Country: _______________________________ Meeting Type: ______________  Meeting Language: ______________ Day: ______ Time: _________________________________ The Steps and Traditions support a diverse and inclusive membership within our Fellowship as well as freedom to every group to define itself:  who attends, descriptions, focus, logistics, timing, etcetera.        i.e.: open, closed, smoking, type of meetings, etc. Group Conscience Comments: ___________________________________________________________________  ___________________________________________________________________________________________ Primary Contact Person Secondary Contact Person Name : _______________________________________ Name : _______________________________________ Address: _____________________________________ Address:  _____________________________________ City: ________________________________________ City: ________________________________________ State: __________________________ Zip: __________ State: __________________________ Zip: __________ Country:  ________________________________ Country:  ________________________________ Phone: (_______) ______________________________ Phone: (_______) ______________________________ E-Mail: ______________________________________ E-Mail: ______________________________________ I give my permission to list my name, phone number and e-mail address in the CoDA Contact Directory. I give my permission to list my name, phone number and e-mail address in the CoDA Contact Directory. Signatures ___________________________________ Signatures ___________________________________ Note: As a contact for your meeting, your first name, last initial, telephone number, and e-mail address will be appearing in the CoDA Contact Directory available on the CoDA web site. By your signature above, you are giving permission to have your first name, last initial, telephone number, and e-mail address given out to those needing a CoDA contact for your meeting. If you provide Mail contact information, you are agreeing to receive written communication for your meeting from within the CoDA organization. Please mark the box yes or no to indicate agreement with statement.  Please sign the form. Please complete one form per meeting Day and Time and return to: Co-Dependents Anonymous, Inc. P.O. Pox 33577 Phoenix. AZ 85067-3577 www.coda.org e-mail to: meeting@coda.org Print PDF | Register Online

rev 02/2008