WRW Registration
(Must be postmarked by the Registration Deadline)

Fill out this registration form on the screen and print it out
or print it out and fill it out by hand.

I cannot attend but please keep me on the mailing list

YES
NO

Have you attended before?

YES
NO

Has your address changed since your last worksop?

YES
NO

Would you willing to receive your registration by email?

Email address: 

 

YES
NO

Are you willing to speak or lead a workshop?
If yes please include your phone number below.

Name

Address

City/State/Zip

phone

(optional)

Sobriety Date
Al-Anon Date
Other Program     Other Date


ALL CABINS NON- SMOKING
NO OUTDOOR GRILLING PERMITTED

Special Needs:

deposit $50.00

$40.00 due on arrival (NOTE: your deposit is NON-REFUNDABLE AFTER
                                    September 2, 2008)

full-paid $90.00

$00 due on arrival

$.00

OPTIONAL WRW Scholarship Donation

$.00

TOTAL amount enclosed

Make check or money order payable to and mail to:
WRW
502 Crane Drive
Lawrenceville, GA 30045

Back to the WRW Home Page

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