Birthday Chip Request Form

We celebrate Al-Anon/Alateen milestones and birthdays at our Speaker Meetings held every other month. You can attend the Speaker Meetings in-person or virtually. We ask you to be present either way to receive your chip. Let us help you celebrate your achievement of another year of recovery with an Al-Anon Birthday Chip!

Schedule of Birthday Chip Speaker Meetings
Frequently Asked Questions

Please enable JavaScript in your browser to complete this form.

First Name *

Years in Al-anon/Alateen *

Birthday Month *Select Birthday MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

Phone Email Years

Are you attending the Speaker Meeting in-person or virtually? *

• In-person
• Virtual

We ask everyone receiving a chip to share their name and years in program during the birthday celebration at the Speaker meeting. Those attending virtually will be asked to share following those in-person.

Want your chip mailed?

• Yes

Chips will be mailed after you attend the Speaker Meeting.

Mailing Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Email *

Required to recieve a confirmation email and for the Birthday Chip Coordinator to be able to respond to any questions.

Phone

Optional

Comments/Questions

Submit