New Meeting Registration Form

Use this form to register a new meeting or to make changes to an existing meeting.

First and Last Name*

Email*

Address

Phone Number*

Secondary Contact Person*

Yes

Secondary Contact First and Last Name

Secondary Contact Email

Secondary Contact Phone Number

Group Name*

Meeting Day*

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Multiple (Please describe in Comment section below)

Start Date*

Month

Day

Year

Meeting Time (USA Eastern Standard Time)*

Time

:HoursMinutes

Meeting Duration Time (ie. 1 Hour)*

Group Representative (GR) Name*

Do you want this meeting published on the XPI Website*

Yes

Description of Meeting to be displayed on CPA site(s) and the Contact Person's preference on how their name will be displayed on the site(s). Please include if this is an Open or Closed meeting *

Type of Meeting*

Face to Face

Online

Phone

Other

XPI Room Number

Room 1

Room 2

Other

If not an XPI Room, please provide the room information or online format details.

Please provide any comments or questions you may have for the Meeting Registrar

"Surrender is the essential ingredient. After years of trying to fix our condition, being at war with it, trying to control it, we finally accept we can’t alter the situation. Just doing this is a remarkable accomplishment."

Chronic Pain Anonymous Service Board. Recipe for Recovery: A Guide to the Twelve Steps of Chronic Pain Anonymous (p. 3).

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