LivingSober

Online Registration Form (all fields with * are required)
Please do not submit form until you are ready to complete payment.
Registrant's First name *
Registrant's Last name *
Email address *
Add my address to the Living Sober email outreach list.	Yes	No
	For news & updates throughout the year. (You can unsubscribe at any time)
	Is the person paying different than the person being registered? No    Yes Enter name of person paying: (ONLY if you are paying for someone OTHER than yourself. Otherwise, please leave BLANK)
Mailing Address *
City *
State *
Zipcode *
New Address?	Yes	No
Phone Number
Which program(s) are you in:	AA Al-Anon Other
Credit card payment via PayPal must accompany online registration. Please do not submit form until you are ready to complete payment. Online forms submitted without payment are automatically deleted from the registration system.

Please fill out the form and click "Continue" to select your Registration choices.

Remember, your Registration is not complete until you have submitted payment on the PayPal site.

To register more than one person, please complete the registration process separately for each individual.

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In order for the conference to be fully self-supporting in accordance with the 7th Tradition, this year Living Sober will be implementing a scholarship application process that must be completed in advance of the conference itself.

Please do not fill out this form if you want to request a scholarship, and check back soon for more information. We will be sending out a notification via our Email Outreach list when applications for scholarships are being accepted.

If you are not already on our Outreach list, please go here to sign up.

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To arrange ASL or special needs, please contact us at steering@livingsober.org after registering.

© 2012 Living Sober