Delegates Day Registration – Arizona Al-Anon/Alateen Family Groups

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This field is for validation purposes and should be left unchanged.

Name*

First Last

Phone*

Email*

Group #*

Name of Group*

District #*

Group's Meeting Location (City)*

How Will You Be Attending?*

In Person

Zoom

Please Select Your Attendance Position

(Check all that apply) Hold down "Control" button to select multiple options on PC/Mac.

Please State Other Position*

Special Lunch?

If needed, check one or both that apply

Vegetarian lunch

Gluten Free lunch

Spanish Interpretation Requested

Yes

Mail-In Payment Date (Treasurer Only)*

Amount Paid (Treasurer Only)*

Payment*

Would you like to make a 7th tradition contribution?

Yes

How much would you like to donate?

Total

Payment Method*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name