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Anniversary Celebration Form
Fill out this form if you would like to celebrate your anniversary with us!
Be sure to update
every year,
around 3 weeks before your anniversary!
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* Indicates required question
Email
*
Your email
What is your name?
*
Your answer
What is your sobriety date?
*
MM
/
DD
/
YYYY
How many years of sobriety will you be celebrating?
*
Your answer
In the section below please fill out your full name (first and last) and mailing address if you would like us to send you a coin and card. If not then you do not have to these fields
What is your full name?
Your answer
Street
Your answer
City
Your answer
State
Your answer
Zip code
Your answer
Will you have someone present your coin?
*
This can be an AA or family member or personal friend. Presenters are asked to give a 1-2 minute introduction on you and your sobriety. If you do not have anyone in mind please just enter "chair", you can add someone later if you want!
Your answer
Send me a copy of my responses.
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