Annual Housecleaning Retreat eRegistration
Electronic Registration for Annual Housecleaning Spiritual Retreat for AA and Al-Anon
As you want it to appear on name tag
(Optional but suggested)
We need you full last name but first initial of your last name will be used on name tag
Please include suite or appt#. Confirmation will be mailed to this address.
2 letter initials of State only please, example; FL for Florida
5 number zip codes only please
Please enter the primary number you use
Initial confirmation will be sent via email
If you do not wish to put a sobriety date, put today's date in the response below
Let us know if you are in AA or Al-Anon or Both
Men with the Men, Women with the Women so we need to know which one you are
Type of room to reserve and payment
Single rooms are limited, we will notify you if we CANNOT accommodate a single room order.
Double occ. room - Pay via paypal
Single occ. roon - Pay via paypal
Double occ. room - Pay via check (must send deposit or full payment)
Single occ room - Pay via check (must send deposit or full payment)
Will you be buying a T-shirt? Pre-orders are guaranteed and set aside for you.
Shirts are purchased separately from registration fee. Only pre-paid shirts are reserved. PayPal has options to include shirts or amount can be added to the check sent in. 100% of proceeds from T-shirts go to scholarships.
Yes - Small
Yes - Medium
Yes - Large
Yes - X-Large
Yes - XX-Large
Yes - XXX-Large
Yes - Multiple (Please specify in Additional Comments
Physical issues we should know about
Please check all that apply to you, use addition comments for any other issues
Trouble with Stairs
I snore loudly
Food alergies, please specify in additional comments
I am over 60 years of age
Example; room with my friend Roger Slusser, I use sleep apnea machine at night, I am allergic to peanuts, etc...
Name of Signifcat other if attending
We do not allow significant others to room together, yes... even married couples.
Do you smoke/vape
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service