xxth Annual
**********************************************
Venue Name
Venue Address
Cost: $ xxx.00*
*Includes lodging & meals beginning with dinner Friday and concluding with lunch on Sunday
** Commuter Fee is $XX this does NOT include lodging
Please complete the registration form below, and enclose your check for $xx.00
Or, register at our web site at https://steps-to-recovery.org
make checks payable to: “Steps to Recovery” & mail to:
PLEASE NOTE NEW ADDRESS
Steps to Recovery Weekend
P. O. Box (changes yearly)
City, State 99999
REGISTRATION WILL BE ACCEPTED ON A FIRST COME, FIRST PAID BASIS.
Reservation confirmations will be mailed or e-mailed during the second full week of January.
Please provide a clear & legible e-mail address (below) in order that your confirmation may be sent via e-mail
Directions and further details will be included in confirmations.
ONLY cancellations made prior to CUTOFF DATE, will be eligible for a refund.
Please note that this is an entirely non-smoking facility – both buildings and grounds.
For further information, contact:
| 4th yr committee member name | Phone Number | Email Address |
| 3rd yr committee member name | Phone Number | Email Address |
| 2nd yr committee member name | Phone Number | Email Address |
-----------------Detach here------------------------------------------------ PLEASE PRINT PLAINLY! --------------------------------------------- Detach here------------
Name: E-mail
________________________________________________ (print CLEARLY please) ___________________________________________________
Street ___________________________________ City______________________ State______ Zip Code________ Birthday___________
Ph: __________________________ Sobriety Date: ____________________ Special requests? _____________________________________
(ex. “1st floor only”, special diet)
Roommate Request__________________________________________________ Scholarship Request No top Bunk
Payment enclosed for Registration $ XXX.00
Scholarship donation (any amount is welcome) + __________ (Thank You!)
*(Scholarships are always sorely needed & greatly appreciated!)
Total enclosed = $ _________