45th National AA Convention Coffs Harbour NSW Australia April 2010

Participant Information

Name :

Fellowship : Al-Ateen Prefered Name for Name Tag:

Home Group : E-mail:

Length of Sobriety AA/ Time in Fellowship Al-Anon :

Phone Number :

Available to speak : Yes No Available to chair : Yes No Available for Service : Yes No

Registration $20 + $1.00 fee

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