Group Officer Registration Form

***In order for a group to be listed in the directory, there must be one regular member who is a Group Contact for that meeting. In addition, in order to be officially registered with the Chicago Area Service Assembly (CASA), groups must have a Group Service Representative (GSR). The number of officially registered groups will determine the number of Voting Delegates to CASA from your district Each group is allowed one GSR and one alternate GSR.***

Group #: -(Group # is listed in the directory)
Position in Group:

	GSR		Group Contact
	Alternate GSR		Treasurer
	Secretary		Other

Officer Information

Name
Address
City
Zip
Phone 1
Phone 2
Cell
Fax
Email*
Term Start Date
Length of term

(Suggested term for GSR/Alternate GSR is 2 years. If you are the Group Contact, we ask that you update your information or register a new contact every year. Contact and/or GSR information must be kept current or your group faces the possibility of being removed from the directory.)

Are you replacing someone?	YesNo
If yes, who?
Additional note to Group Services Coordinator

*Email required to submit electronically.

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Contact: Group Services or the Webmaster