WRW Scholarship Registration Form

WRW SCHOLARSHIP Registration Form (Must be postmarked by the Deadline for Scholarship Registration)
Fill out this registration form on the screen and print it out or print it out and fill it out by hand.
YES NO	Is this your first WRW Scholarship?
YES NO	Have you attended before?
YES NO	Has your address changed since your last workshop?
YES NO	Would you be willing to receive your registration by email? Email address:
YES NO	Are you willing to speak or lead a workshop? If yes please include 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:
I contacted who is a member of the Scholarship Committee. She approved my scholarship and I agreed to pay .00 (which is NON-REFUNDABLE) toward the $90.00 Full Registration Fee. Applications that do not include the agreed to amount will not be accepted.
Make check or money order payable to and mail to: WRW 502 Crane Drive Lawrenceville, GA 30045