C.E.R.A.A.S.A
Canadian Eastern Regional Alcoholics Anonymous Service Assembly
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English registration form
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Name
*
First
Last
Email
*
Name on Badge
Area
Phone Number
*
111-111-1111
Street Address
Addition Address (unit, APT #, Box)
Town/City
Province/State
Country
Postal Code/Zip
Service Position
GSR or Alt. GSR
DCM or Alt. DCM
District Committee
Central Office/Intergroup
Area Committee
Area Officer
Delegate or Alt. Delegate
Past Delegate
Please State Area and Panel Number
Other Service Position
If none of the above fit.
Please select which ones apply to you....
This is my first time attending CERAASA
I would like to participate in a presentation
I would like to moderate or record in a panel
I have been a CERAASA presenter before
I would like to volunteer to be a Greeter
I Would like to volunteer with Hospitality
I would like to volunteer with Registration
I would like to volunteer with transportation
Comments / Addition requirements / Special Needs
How many Registrations? $40.00 each
*
How many Banquet Tickets? $45.00 each
*
How Many Guest Banquet Tickets? $45.00 each
*
How many Ice Cream social? $11.00 each
*
Total Payable
Please add your items and put total value of e-transfer here.
Payment
*
E-transfer funds
E-Transfer to: ceraasa2021@bell.net
Any comments, Questions or Concerns
Phone
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