Bridging the Gap Workshop Weekend Temporary Contacts

Alcoholics Anonymous bridging the gap temporary contact on release corrections treatment AA

Alcoholics Anonymous Temporary Contacts

	Please fill out the form below with as much information as possible
Treatment or Correctional Facility Name:
Facility Address:
City:		State:	Zip:
Counselor or Aftercare Coordinator or contact:
E-mail address:
Contact Phone Number:
Client/Offender's Name & ID Number:
Release to Address:
City:		State:	Zip:
Gender:		Birthdate or approximate age:
Discharge Date:
	Please type the letters and numbers from the box above into the box below (you must match capital and lower case letters)

Site information was last updated on Fri, Jun 08 2018 Alcoholics Anonymous bridging the gap temporary contact on release corrections treatment AA