Tribute – Things We Cannot Change

In Memory of

Your Archives Committee is spearheading this project and could use YOUR help with this event. We are hosting a slide show remembering all of our members who have served and passed. Please fill out the following information to the best of your ability. If you have any questions, and to submit photos, please contact archives@aainsa.org.

Name of Honorary *

First

Last

Sobriety Date

Home Group

Next of Kin

Disclaimer: For this project, we will need to get a release from the Next of Kin for information and photos to be shown at Weekend in SA. The Archives Committee will follow up with the Next of Kin. If we are unable to obtain a release, this memorial will not be able to be shown.

Contact Name *

First

Last

Contact Phone

Contact Email

Nomination Contact

Person or Group submitting the nomination.

Name *

First

Last

Group Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Donation

We ask for a suggested donation of $20 to cover the costs of copying/scanning photos & equipment rental. If needed, please check below for a scholarship. DO NOT LET THE SUGGESTED DONATION DETER YOU FROM SUBMITTING A NOMINATION.

Select an Option *

Will Make Donation - See options below - select after clicking SUBMIT
Need a Scholarship

Message

Donation

$5.00 – $30.00

Select options