Internet Registration Form

Name         Name on Badge

Address       City,State,Zip    

Phone     Email  

Please e-mail me convention updates and future convention information

Sobriety Date  Home Group Name   

Home Group Location in Georgia

Your Home Group Affiliation       AA        Al-Anon          Alateen 

Planned Events: (Check form boxes of events which You expect to attend)  

Golf Outing * __   Participation fee will be due upon arrival for the event * 

Open Mic Coffee House __    

Motorcycle Poker Run __    

SPECIAL NEEDS: (Check all form boxes which apply)

Wheelchair    Sight      Hearing    Other

Out-of-State Visitor Requirements:

Group Affiliation              AA         Al-Anon          Alateen 

Out-of-State registration fee AA & Alanon: $25.00_Advance Fee
Out-of-State registration fee Alateen: $10.00_Advance Fee

'Advance Fees' are payable when this form is submitted

Checks or Money Orders Only, Please ! Cash or Cards will Not Be Accepted