2025 Area Convention Registration Form Please complete the following information: Step 1 of 4 – Contact Information and Registration 25% Name(Required) First Last Email(Required) Phone(Required)Badge NameThis is how your name will be printed on your conference badge Are you an… AA Al-Anon/Alateen Guest/Other Convention Registration for One(Required)Each attendee must complete this form and pay separately so we have each individuals information Price: Convention Scholarship FundWould you like to contribute to the scholarship fund for AA’s who would otherwise not be able to attend? ($30 allows one person to receive a scholarship to attend)Not this timeI'll contribute $5I'll contribute $10I'll contribute $15I'll contribute $30I'll contribute $60Total If you are Vegan, Vegetarian, Dairy Free, or Gluten Free, you MUST select the “Special Meal” option for Friday and Saturday night dinners. The chef cannot adjust the other dinner options to accommodate allergies.Friday Night Plated Dinner (optional)No Friday Dinner ($0)Herb Crusted Chicken ($50)Traditional Baked Haddock ($55)Special Meal ($50) (Vegan, Vegetarian, Dairy Free, Gluten Free)Saturday Night Plated Dinner (optional)No Saturday Dinner ($0)Saturday Bruschetta Chicken ($50)Saturday Pan Seared Salmon ($55)Special Meal ($50) (Vegan, Vegetarian, Dairy Free, Gluten Free)Saturday Morning Breakfast Buffet (optional)No Saturday Breakfast ($0)Yes, Saturday Breakfast ($28)Sunday Morning Breakfast Buffet (optional)No Sunday Breakfast ($0)Yes Sunday Breakfast ($28)Please list all food allergies Total Unisex Pull Over Hooded Sweatshirt (optional) Quantity Price: $35.00 Quantity Unisex Pull Over Hooded Sweatshirt SizeSmallMediumLargeXL2XL3XL4XLLadies V-Neck T-Shirt (optional) Quantity Price: $20.00 Quantity Ladies V-Neck T-Shirt SizeLadies v-neck shirt runs small, our vendor suggests going up a sizeX-SmallSmallMediumLargeXL2XL3XL4XLUnisex Crew Neck T-Shirt Quantity Price: $20.00 Quantity Unisex Crew Neck T-Shirt SizeX-SmallSmallMediumLargeXL2XL3XL4XLTotal Total Credit CardCard Details Cardholder Name Billing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands