Delegates/Past Delegates Convention

February 10-12, 2006

Radisson Hotel & Convention Center

11800 - 108th Street

Pleasant Prairie Wisconsin 53158

(262) 857-3377

Questions?  Nancy G. (608) 221-2891 - [email protected]

Or Jo Mc (262) 551-7371 - [email protected]

Make checks payable to: Delegate/Past Delegates 2006

Mail to: Bill H., 1233 Layard Ave, Racine, WI  53402

No refunds after January 20, 2006

Saturday Night A.A. Speaker      Adrienne B. GSO Staff

Please print all information – To sit together send the forms together (max 10 people)

Name____________________________________________________

Address___________________________________________________

City______________________State____Zip______Area____Panel____

How do you want your name on your badge? _____________________

Circle one: Trustee/Past Trustee, Delegate/Past Delegate, Area Officer/Chair

DCM/GSR/District Committee – AA member - Al-Anon – Guest - Newcomer

 Special Needs/Special Meals Request (may incur extra cost) ___________

Registration           $20.00                  _______

4 meal package      $85.00                  _______

Banquet Only          $28.00                 _______