Copy the following to an e-mail, fill in information, then E-Mail  to:  andreamacd@msn.com

WSO IG #: 

Intergroup Name: 

Event Day, Time, Place:  

Type of Funding:   

  (Choose one:  First-Time” Intergroup   or   S&T   or   Speaker   or   WSBC)

Name of Person to be funded: 

Contact Name: 

Phone:  

Mailing Address: 

City, State, Zip:  

Amount Requested: 

Submitted By:  

Date: