Area 21 Alcoholics Anonymous ride provider form to bring those coming out of treatment to meetings
A barrier for many people coming out of treatment is having a ride to get to a meeting, or knowing someone they can call for a ride to a meeting. The goal of this form is to provide a list of people that are willing to provide rides to those coming out of treatment.

The purpose of this form is to collect information from those in Alcoholics Anonymous in Southern Illinois that are willing to provide rides to meetings for those coming out of treatment. 

Information collected using this form will only be shared with the Area 21 treatment chair to organize this information, DCMs if no bridging the gap chair is within their district, bridging the gap chairs, and intergroups/central service/clubs that have a hotline to provide information. Your first name and list initial with phone number will then shared with a person coming out of treatment needing a ride to a meeting. Your email will be used to confirm receipt of this form. You are welcome to fill out this form multiple times for different meetings. 
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Email *
What is your name? Please use your first name and last initial.  *
What is your phone number? Please include your area code.  *
What sex are you? For safety reasons, you will be matched with those of similar sex.  *
What is the name of the meeting you would be willing to take the person to? *
Which day(s) does it meet on? *
Required
What is the name of the city where the meeting is located? *
Please list the time of the meeting. *
Time
:
What district are you a part of? If you do not know, please select, "I am not sure". *
Thank you so much for your willingness to help those coming out of treatment! If you have any questions for the Area 21 Treatment Chair, please email area21treatment@gmail.com
A copy of your responses will be emailed to the address you provided.
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