Central California Area Assembly Group Contribution Form

Send Contributions to:

Central California Area

606 Alamo Pintado #140

Solvang, CA 93463

Group information GSO #___________________

Group Name ________________________________________________________________________

Meeting Day___________________ Time(s) ______________________________________________

Address_____________________________________________________________________________

City____________________________________ Zip________________________________________

Send Receipt to:

Name ____________________________________________Date______________________________

Address____________________________________________________________________________

City _____________________________________________Zip________________________________