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Club Roster Form

To correct your listing on the Official Roster of NSA Clubs in the US and Canada or to verify information for the yearly Roster update, please send us the following information. You may mail a physical copy of this form (photocopies of the printed original or printed copies of the web version are acceptable), or e-mail us an electronic copy of this web page. We regret that we do not yet support automatic HTML form submission of this information.

If your club meets in your home, and you don't want the address listed or the time/location is not consistent, please write "CALL FOR INFORMATION" on meeting location line.

NSA CLUB #: _____  CITY: __________________ STATE/PROVINCE: _____
Where and when does the club meet?

DAY OF WEEK/MONTH: __________________  TIME OF DAY: _____________

ADDRESS/DIRECTIONS: _____________________________________________

_________________________________________________________________

(OPTIONAL) MEETING LOCATION PHONE NUMBER: (___) ___-____
Who is/are the Club Director(s)?

NAME: ____________________________  PHONE: (___) ___-____        

ADDRESS: ________________________________________________________

E-MAIL: _________________________________________________________


NAME: ____________________________  PHONE: (___) ___-____        

ADDRESS: ________________________________________________________

E-MAIL: _________________________________________________________


NAME: ____________________________  PHONE: (___) ___-____        

ADDRESS: ________________________________________________________

E-MAIL: _________________________________________________________

 

 

 

If you do not wish to be listed on the roster, please complete the appropriate section(s):
Please remove my club from the NSA Roster:

  CLUB #: ______  DIRECTOR'S NAME: ______________________________

  REASON: _______________________________________________________
        
I wish to be removed from the Director's List and mailings.

  DIRECTOR'S NAME: ______________________________________________

  REASON: _______________________________________________________
        
I have passed the Director's Test but do not have a club now.

  DIRECTOR'S NAME: ______________________________________________

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