MEMBER ANNIVERSARY SUBMISSION FORM
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NAME OF CELEBRANT

ENTER THE FIRST NAME ONLY PLEASE   
SELECT LAST INITIAL     ********* A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

THE DATE THEY ARE CELEBRATING
(not the sobriety date)

SELECT THE MONTH    ********** JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER
SELECT THE DAY    ******** 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 18 19 20 21 22 23 24 25 26 27 28 29 30 31

GROUP CELEBRATING

SELECT THE GROUP    ************ Almonte Closed Discussion Athens 3rd Tradition Autonomy Group Back To Basics Brockville Big Book Step Discussion Perth Big Book Study Meeting Smiths Falls Brockville Sunday Morning Group Closed Discussion Smiths Falls Elgin Closed Discussion Meeting Friendship Group Grapevine Meeting Heritage Valley Group Highlands Discussion Group Land-O-Lakes Group Merrickville Sunday Night Mississippi Group Monday Night Womens Group New Beginnings Group New Hope Group Perth Sunday Morning Breakfast Perth Tay Group Phoenix Group Primary Purpose Saturday Night Smiths Falls Seaway Group Smiths Falls By The Book 12 Step Sunday Morning Smiths Falls Sunshine Group Thursday Night 12 Step Group 12 and 12 Step Meeting Smiths Falls 12 and 12 To Serenity Westport By The Book Young Peoples Group Brockville

YEARS CELEBRATING

SELECT HOW MANY YEARS CELEBRATING    ******* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65