Barrie AA Intergroup

Contact Us - Medallion Order Form

Important Notes:

All medallion prices include engraving.
Medallions are sent out for engraving on Fridays and are delivered to the Intergroup office, ready for pick up on Mondays.

To help ensure you receive your medallion in time for the day of the Medallion celebration, please place your order 3 weeks prior to when they are required.

Please complete the form, and confirm that the spelling, grammar, and date are correct before submitting.

Your Name

Group Name

Phone Number (where you can be reached)

Email

Additional Message / Questions?

First Name & Initial (as it will appear on Medallion)

Sobriety Date (mm/dd/yyyy)

Medallion Required e.g. (1, 5, 10, 15, 20, 25, 30, 35, 40, 45, 50)

Engraving - Message (maximum of 30 characters)