Appointment to General Service Board of AA Ireland

Service Position(Required)

Director / AA Trustee

Director / Trustee

Company Secretary

Provincial Intergroup(Required)

Leinster Intergroup

Munster Intergroup

Connaught Intergroup

Ulster Intergroup

Term Start Date(Required)

Term Finish Date

Contact Name(Required)

First Last

Address(Required)

Street Address Address Line 2 Town / City County Eircode

Phone(Required)

Date of Birth

PPS Number

Director of Another Company(Required)

YES

If YES Enter CRO Number of Company

Official AA Mailbox Address(Required)

Date Form Submitted(Required)