May 2019 West Texas Assembly Registration
Please complete the form below so we can use it for anticipating numbers at this year's assembly and to electronically print name-badges prior to our event. Thank you- WTA AWSC
First (Preferred) Name
Your answer
Last Name
for questions or contact purposes only
Your answer
Name on Badge
Your answer
Program
Please select meat/bread type for your subway sandwich, if you are buying multiple sandwiches you may check more than one.
Address
(street)
Your answer
City, State ZIP
Your answer
Home Group
Your answer
Email address
Your answer
Name of Responsible Adult
(for Alateens only)
Your answer
Phone number
Your answer
For online payments: please provide the last name on the credit card you will be using so that we can match the payment to the registration.
Your answer
Thank You For Registering!!!
Online Payments: Click "Pay Online" at the top of this page to make your selections and complete payment (Please make sure last name on credit card is listed above)

To mail in payment
Al-Anon or AA ticket= $20 each, Alateen ticket=$5 each, Luncheon Sandwich (Subway)=$6.50 each

Send payments to:
Peggy Dragna, WTA Treasurer
5325 Madella Street
Haltom City, TX 76117

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