12 Steps to Recovery Retreat Registration    Friday, August 22nd - Sunday, August 24th 2025
This form is for registration only.  Return to the retreat website to pay for your registration and make any contributions to the scholarship fund:


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Email Address *
Name *
Sobriety Date *
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DD
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YYYY
City *
State *
Mobile Phone *
Requested Roommate *
Please remember most rooms accommodate 2 people. Failure to put a roommate preference will lead to the committee selecting a roommate for you as needed.
Physically Disabled? *
Special Dietary Needs
Please leave blank if no special dietary needs are required
Do you need Scholarship Assistance
Please note that scholarship funds are limited by the number of donations we receive each year. Once we receive your request for assistance, a member of the leadership team will reach out to you to see if we can help.
 *
If you do need scholarship assistance,  how much, if anything, are you able to contribute toward your registration?
Leave blank if you do not require scholarship assistance
Pledged amount to be applied to the scholarship fund?

Each year men who have experienced Fatima themselves offer to help support men who would not be able to attend without financial support. Your willingness to share any additional resources, no matter the amount, is greatly appreciated. 

If you would prefer a member of the leadership team contact you to discuss your contribution, please indicate that in your response below.
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