Name* Badge Name* Main registrantAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Phone*Email* Enter Email Confirm Email Registration type* AA Al-Anon AA/Alanon Non-Program Alateen (13-19) Preteen (10-12) Tween (7-9) 6 and under Will you be playing in the Bill Wilson Open Golf Tournament? No Yes HandicapPlease enter a number from 1 to 40.4.Purchase mulligans 1 Mulligan 2 Mulligans 3 mulligans 4 Mulligans Is this your 1st year at the conference?* Yes No How many years have you been in AA or Al-Anon?* Please check the areas that you are willing to provide services for Workshop leader Discussion Leader Activities Information desk Green Shirts Alateen Preteen Tween Please add any additional comments belowHow many additional people are you registering for this event?*Please enter a number from 0 to 6.Registrant +1Name of additional registrant 1* Badge Name of additional registrant 1* Registration type* AA Alanon AA/Alanon Non-Program Alateen Preteen (10-12) Tween (7-9) 6 and under Please let us know the age of this registrant.*Please select an age12345678910111213141516171819Registrant 1- Bill Wilson Open Golf Tournament?Will registrant 1 also be playing in the Bill Wilson Open Golf Tournament? No Yes HandicapPlease enter a number from 1 to 40.4.Purchase mulligans 1 Mulligan 2 Mulligans 3 mulligans 4 Mulligans Additional registrant 1Registrant +2Name of additional registrant 2* Badge Name of additional registrant 2* Registration type* AA Alanon AA/Alanon Non-Program Alateen Preteen (10-12) Tween (7-9) 6 and under Please let us know the age of this registrant.*Plesae select an age12345678910111213141516171819Registrant 2 - Bill Wilson Open Golf Tournament?Will this registrant also be playing in the Bill Wilson Open Golf Tournament? No Yes HandicapPlease enter a number from 1 to 40.4.Purchase mulligans 1 Mulligan 2 Mulligans 3 mulligans 4 Mulligans Additional registrant 2Registrant +3Name of additional registrant 3* Badge Name of additional registrant 3* Registration type* AA Alanon AA/Alanon Non-Program Alateen Preteen (10-12) Tween (7-9) 6 and under Please let us know the age of this registrant.*Plesae select an age12345678910111213141516171819Registrant 3 - Bill Wilson Open Golf TournamentWill this registrant also be playing in the Bill Wilson Open Golf Tournament? No Yes HandicapPlease enter a number from 1 to 40.4.Purchase mulligans 1 Mulligan 2 Mulligans 3 mulligans 4 Mulligans Additional registrant 3Registrant +4Name of additional registrant 4* Badge Name of additional registrant 4* Registration type* AA Alanon AA/Alanon Non-Program Alateen Preteen (10-12) Tween (7-9) 6 and under Please let us know the age of this registrant.*Plesae select an age12345678910111213141516171819Registrant 4 - Bill Wilson Open Golf Tournament?Will this registrant also be playing in the Bill Wilson Open Golf Tournament? No Yes HandicapPlease enter a number from 1 to 40.4.Purchase mulligans 1 Mulligan 2 Mulligans 3 mulligans 4 Mulligans Additional registrant 4Registrant +5Name of additional registrant 5* Badge Name of additional registrant 5* Registration type* AA Alanon AA/Alanon Non-Program Alateen Preteen (10-12) Tween (7-9) 6 and under Please let us know the age of this registrant.*Plesae select an age12345678910111213141516171819Registrant 5 - Bill Wilson Open Golf Tournament?Will this registrant also be playing in the Bill Wilson Open Golf Tournament? No Yes HandicapPlease enter a number from 1 to 40.4.Purchase mulligans 1 Mulligan 2 Mulligans 3 mulligans 4 Mulligans Additional registrant 5Registrant +6Name of additional registrant 6* Badge Name of additional registrant 6* Registration type* AA Alanon AA/Alanon Non-Program Alateen Preteen (10-12) Tween (7-9) 6 and under Please let us know the age of this registrant.*Plesae select an age12345678910111213141516171819Registrant 6 - Bill Wilson Open Golf Tournament?Will this registrant also be playing in the Bill Wilson Open Golf Tournament? No Yes HandicapPlease enter a number from 1 to 40.4.Purchase mulligans 1 Mulligan 2 Mulligans 3 mulligans 4 Mulligans Additional registrant 6Handling fee Price: $0.00 Registration fee total $0.00 Conference Information Opt-In Yes, I would like to receive my conference registration packet via email. Yes, I would like to receive annual information by email about the conference and receive updates about this year’s conference. Please note that we only anticipate that this will result in a total of 2-3 emails per year from the conference.