Name*Badge Name*Main registrantAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Phone*Email* Enter Email Confirm Email Registration type*AAAl-AnonAA/AlanonNon-ProgramAlateen (13-19)Preteen (10-12)Tween (7-9)6 and underWill you be playing in the Bill Wilson Open Golf Tournament?NoYesHandicapPlease enter a number from 1 to 40.4.Purchase mulligans1 Mulligan2 Mulligans3 mulligans4 MulligansIs this your 1st year at the conference?*YesNoHow 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*AAAlanonAA/AlanonNon-ProgramAlateenPreteen (10-12)Tween (7-9)6 and underPlease 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?NoYesHandicapPlease enter a number from 1 to 40.4.Purchase mulligans1 Mulligan2 Mulligans3 mulligans4 MulligansAdditional registrant 1Registrant +2Name of additional registrant 2*Badge Name of additional registrant 2*Registration type*AAAlanonAA/AlanonNon-ProgramAlateenPreteen (10-12)Tween (7-9)6 and underPlease 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?NoYesHandicapPlease enter a number from 1 to 40.4.Purchase mulligans1 Mulligan2 Mulligans3 mulligans4 MulligansAdditional registrant 2Registrant +3Name of additional registrant 3*Badge Name of additional registrant 3*Registration type*AAAlanonAA/AlanonNon-ProgramAlateenPreteen (10-12)Tween (7-9)6 and underPlease 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?NoYesHandicapPlease enter a number from 1 to 40.4.Purchase mulligans1 Mulligan2 Mulligans3 mulligans4 MulligansAdditional registrant 3Registrant +4Name of additional registrant 4*Badge Name of additional registrant 4*Registration type*AAAlanonAA/AlanonNon-ProgramAlateenPreteen (10-12)Tween (7-9)6 and underPlease 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?NoYesHandicapPlease enter a number from 1 to 40.4.Purchase mulligans1 Mulligan2 Mulligans3 mulligans4 MulligansAdditional registrant 4Registrant +5Name of additional registrant 5*Badge Name of additional registrant 5*Registration type*AAAlanonAA/AlanonNon-ProgramAlateenPreteen (10-12)Tween (7-9)6 and underPlease 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?NoYesHandicapPlease enter a number from 1 to 40.4.Purchase mulligans1 Mulligan2 Mulligans3 mulligans4 MulligansAdditional registrant 5Registrant +6Name of additional registrant 6*Badge Name of additional registrant 6*Registration type*AAAlanonAA/AlanonNon-ProgramAlateenPreteen (10-12)Tween (7-9)6 and underPlease 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?NoYesHandicapPlease enter a number from 1 to 40.4.Purchase mulligans1 Mulligan2 Mulligans3 mulligans4 MulligansAdditional 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.
