EURYPAA 2010 Registration Form

ATTENDEE (All fields are requested)
LAST NAME
FIRST NAME
NICKNAME ON BADGE
ADDRESS
CITY ST/PROV
ZIP/POSTAL CODE
COUNTRY
E-MAIL

BADGE TYPE
IF FRIEND/SPOUSE, NAME OF ATTENDEE YOU ARE COMING WITH

SOBRIETY DATE

AGE GROUP

FIRST YOUNG PEOPLE IN AA CONVENTION?
Yes
No

OTHER YPAA CONVENTIONS ATTENDED IN THE PAST

FAVORITE AA CONVENTIONS

YES, I WOULD LIKE TO DO SERVICE DURING EURYPAA 2010

YES, I WOULD LIKE TO HELP WITH OUTREACH FOR EURYPAA 2010

SEND INFO ON BIDDING TO BE THE HOST CITY FOR EURYPAA 2011