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Register and Pay

If you need scholarship, please use our scholarship registration form instead

Name and address

First name *
Last name *
Email *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone *

Information for the event

Sobriety date
Name for badge
Please check if applicable
I am disabled Information for persons with disabilitiesI need scholarship Information on scholarshipI need RV parking

Payment

Please check the items you will be paying for. You will be transferred to the payment page after submitting this form.

Registration

Registration
Registration for myself ($175)Registration for someone else ($175 per person)
If you are paying for someone else, please enter the name/s of the person/s:

Shirts

Optional: I hereby order the following shirts:
Imprinted 100% cotton heavy weight T-shirts and hoodies:
Short sleeve T-Shirt ($20)
Short sleeve T-Shirt MShort sleeve T-Shirt LShort sleeve T-Shirt XLShort sleeve T-Shirt 2XLShort sleeve T-Shirt 3XLShort sleeve T-Shirt 4XL
Long sleeve T-Shirt ($25)
Long sleeve T-Shirt MLong sleeve T-Shirt LLong sleeve T-Shirt XLLong sleeve T-Shirt 2XLLong sleeve T-Shirt 3XLLong sleeve T-Shirt 4XL
Hoodie, Pull-Style ($40)
Hoodie, Pull-Style MHoodie, Pull-Style LHoodie, Pull-Style XLHoodie, Pull-Style 2XLHoodie, Pull-Style 3XLHoodie, Pull-Style 4XL
Hoodie, Zip-Style ($40)
Hoodie, Zip-Style MHoodie, Zip-Style LHoodie, Zip-Style XLHoodie, Zip-Style 2XLHoodie, Zip-Style 3XLHoodie, Zip-Style 4XL