2022 Convention Registration

NENY Area 48 2022 Convention Registration

November 4 - 6, 2022
All information provided here will be kept private

DO NOT PRESS [ENTER] UNTIL YOU ARE THE END OF THE FORM
Full Name *

First Name Last Name
How would you like your name to appear on your name tag?
E-mail *
example@example.com
Phone Number

Area Code Phone Number
Area
District
City
Homegroup and/or Service Position
Check if you are a GSR

Yes, I'm a GSR
Registration Type

AA Al-Anon
Sobriety Date

Month Day Year
Date
Interested in serving ?

Volunteer yourself or Group for Hospitality Room as a panelist as a moderator as a reader as a timer on Long Timer's Panel (25+ years)
Any special requirements? ASL, Translation, Accessibility, or Dietary?
Select from the list below to complete your registration

A Convention Badge is required to attend sessions.

Convention Registration Fee $ 20.00

****** Required to attend sessions ******

Sunday breakfast buffet $ 10.00

Contribution for scholarships - starting at $ 1.00

Select the amount you would like to donate:

Amount

Total $ 0.00

If you contribute $10 or more please be sure to provide your mailing address so we can send you the commemorative pin!
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Thank you!

As the convention gets closer we will use the email address provided to send meeting login information as well as any other updates.
Should be Empty:

NENY Area 48 2022 Convention Registration