Registration Form: Intensive Big Book Workshop
This Intensive Big Book Workshop Weekend is a spiritually centered event for those working Alcoholics Anonymous 12-Step Program. Participants must be at least 6 months in recovery and actively working the 12 steps with a sponsor.
Email address *
Accommodation Details *
Contact Information
Name (Last, First) *
Your answer
Address (Please provide your full address ex.Street, City, State, and Zip Code) *
Your answer
Date of Birth *
Best Contact Number *
Your answer
Email Address *
Your answer
Emergency Contact ( Please include their name, relationship and best form of contact) *
Your answer
Health Information
Please describe any health concerns (physical, psychological) special needs, or dietary allergies or restrictions we should be aware of. *
Your answer
Medical Insurance Information (Please include Insurance Carrier, Health Card Number and Group ID) *
Your answer
Additional Information Requested
Please describe your workshop experience over the last three years and how these workshops have affected your life.
Your answer
What are your expectations and hopes for this Intensive Big Book Weekend Workshop? *
Your answer
Please mention anything else you'd like us to know as we review your registration and prepare to accompany you on our weekend workshop.
Your answer
Please read before submitting your registration
When you submit this form you will be sent a confirmation that shows the data you submitted. You MUST successfully pay your registration fee before you spot is secured.

To secure a spot, please submit your non-refundable $50.00 deposit in either of the following ways:
Payment Options: Check, Cash, Credit Card
Please contact Community Impact Office 508-422-0242 for Credit Card Payments
If mailing a check or money order, please include your name and Workshop in Memo
Community Impact Attn: Workshop Registration 12 Main Street Milford, MA. 01757

Upon payment of your registration, you will receive an email showing receipt of payment and the amount paid. It is this email that will indicate you have properly completed your registration and workshop attendance is secured. Included in this email will be Workshop Participation & Waiver of Liability Agreement to be electronically or physically signed and returned with full workshop payment.

Total amount due must be paid and received by October 14th, 2019 by the Community Impact office.
*No registration accepted without a deposit*
Registration/Cancellation cut-off date is October 11, 2019.

Cancellation Policy:
If cancellation is made on or before October 11,2019, all monies will be refunded except for the $50.00 deposit.
*Please note if weather conditions prohibit this retreat each participant will receive a full refund.
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