Search Our Site
Search


Read The Big Book and Twelve and Twelve

Online Forum Registration

Please fill out the form and press the Send button to register

(Information collected is confidential and will only be used for communication about this Regional Forum.)




First and Last Name:


How would you like your name to read on your badge? (For Example:  First Name and Last Initial; First and Last Name; Nickname; etc.)


Street Address ( NOT E-MAIL PLEASE):


City:



State/Province:



Zip/Postal Code:



Telephone:

- -

1. Are you a French-speaking member who requires translation?
Yes No

2. Are you a Spanish-speaking member who requires translation?
Yes No

3. American Sign Language interpretation is available upon request. Please contact regionalforums@aa.org


4. Have you ever attended a previous Regional Forum?
Yes No

5. Do you want to receive the Final Forum Report electronically? If yes, please provide your e-mail address: