SA/S-Anon 2019 Newcastle Conference Registration
November 16-11- 2019 Newcastle


Contact Details
One Registration form per person.
Given Name *
Your answer
Family Name *
Your answer
Phone number
Your answer
Email Address *
Your answer
Fellowship *
Which fellowship are you a member of?
Do you have any special dietary requirements? This is only if you have a strict dietary requirement that is essential to your health and well being (e.g. food allergy): not for likes and dislikes of foods. *
Your special dietary information must be advised by email to
SA Members Only: To help us choose speakers and meeting chairs which sobriety length category are you in
Do you require assistance with transport to the venue? *
Venue & Registration Payment *
Payment is for food during the event and venue hire for the conference (accommodation not included). The conference will be held at 2A Northern Ave, Tarro NSW 2322
Additional donation (optional)
An additional contribution can also be made to assist with the running of the conference
Registration & optional donation payments can be made by direct deposit to:
Greater Bank BSB: 637000 Account number: 719949118
For your direct deposit payment please specify your payment reference details below: *
Direct Deposit: eg Peter S Brisbane
Your answer
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