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Register online and pay at the retreat

Please have your credit card, cash or check ready for payment at the retreat.

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 disabledI need RV parking

Payment

Please check the items you will be paying for at the retreat:

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