Registration Full Package

Name Name * First Last
Phone Phone - ### - ### ####
Email *

Confirm Email Address *

Email is used for Registration Confirmation.
Badge Name *
Home Group *
Length of Sobriety

Years, Months or Days
Sobriety Date Sobriety Date / MM / DD YYYY
ADA Member

ADA Member Yes No
AA Member or Guest *

AA Member or Guest AA Member Guest
Speak on Panel

Speak on Panel Yes No
Conference Registration Full Package Only (All Meals Included) *

Conference Registration Full Package Only (All Meals Included) Full Package

$180.00 (If Pre-Paid Before February 3, 2023) $190.00 (If Paid After February 3, 2023)
Conference Meals:
Friday Meal

Friday Meal Taco bar
Saturday Lunch

Saturday Lunch Ports of Call Deli Sandwich
Saturday Evening Buffet *

Saturday Evening Buffet Carved Prime Rib Chicken Supreme
Sunday Morning

Sunday Morning Breakfast Buffet
Please select size and quantity
(color cannot be determined at this time due to supply shortages, first come first serve)
T-Shirt

Starting at $14.00
Pullover Hoodie

Starting at $30.00
Zip Hoodie

Starting at $34.00
Additional sizes are available upon request
$0

Total