Contribution – Group/District

Date

Is this contribution for a District or Group? *

District Number *

District 1 Group Name *

District 2 Group Name *

District 3 Group Name *

District 4 Group Name *

District 5 Group Name *

District 6 Group Name *

District 7 Group Name *

District 8 Group Name *

District 9 Group Name *

District 10 Group Name *

District 11 Group Name *

District 12 Group Name *

District 13 Group Name *

District 14 Group Name *

District 15 Group Name *

District 16 Group Name *

District 17 Group Name *

District 18 Group Name *

District 19 Group Name *

District 20 Group Name *

District 21 Group Name *

Is the WSO# shown with your Group's name correct? *

Yes

No

Please enter the correct WSO # *

First Name *

Last Name *

Contact Email *

Contact Telephone Number *

Billing address associated with the credit card to be used for payment *

Billing address associated with the credit card to be used for payment

City

State/Province

Zip/Postal

Please select one entity from the drop down list below. Only one entity can be selected for each contribution form submission

If donating to Al-Anon/Alateen Convention, what year?

Amount of Donation *

$

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Contribution for Group/District of Al-Anon Family Groups of Georgia, Inc.

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