Bridging the Gap – Volunteer Registration Form

Many A.A. members can tell you that, even though we were aware of A.A. we were too fearful to go alone. In order to Bridge the Gap between Facility (treatment & corrections) and A.A., individual members have volunteered to be Temporary Contacts.

Bridging the Gap - Volunteer

Name *

Preferred Contact (email or phone number) *

Alternate Contact (email or phone number)

Sobriety Date *

Home Group *

District Number

I am willing to bridge members from: (check one or both) *

• Treatment
• Corrections

What is your gender? *

• Female
• Male
• Non-binary
• Transgender
• Intersex
• I prefer not to say
• Let me type

Choose as many as you like. If you would prefer to type in your answer, please select "Let me type", and do so in the "Message / Comment" box below.

Message / Comment

Submit