Alcoholics Anonymous : Online Forum Registration

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

Which Forum are you registering for?
First and Last Name
BADGE: In the box below, type the name you prefer on your badge for the Forum.: (Example: “Pat”, “Pat J.”, “Pat Johnson”)
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Have you ever attended a previous Regional Forum?: Yes
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Do you want to receive the Final Forum Report electronically? If yes, please provide your e-mail address here

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Online Forum Registration

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