REGISTRATION FORM

Submit one form for each person registering

Convention registration does not include a hotel registration

Contact the Sheraton Music City for room reservations

ALL REGISTRATION INFO WILL BE KEPT STRICTLY CONFIDENTIAL-PLEASE PRINT CLEARLY

NAME:___________________________________ □ SA □ S-ANON □ BOTH □ S-ATEEN

ADDRESS:____________________________________________________________________

CITY:______________________________________STATE/COUNTRY____________________

ZIP/POSTAL CODE:________________PHONE(INCLUDE AREA CODE):____________________

EMAIL:_______________________________________________________________________

NAME(S) TO APPEAR ON NAMETAG(S)______________________________________________

HOME GROUP TO APPEAR ON NAME TAG(S)__________________________________________

ARE YOU WILLING TO DO SERVICE? (Check the areas where you would like to offer assistance

and a representative will contact you to match you with the convention needs)

□ CHAIR MEETING □ REGISTRATION TABLE □ LITERATURE TABLE

□ CONVENTION SPONSOR □ TALENT SHOW □ GENERAL (WHEREVER NEEDED)

WANT TO BE ON THE CONVENTION’S CONTACT LIST? IF YES, CHECK HERE □

IN ADDITION TO YOUR FIRST NAME AND LAST INITIAL, ADD □ PHONE NO. &/OR □ EMAIL

ADDRESS

REGISTRATION FEE (CHECK ONE):

POSTMARK BY:	SA/S-ANON WITH MEALS	SA/S-ANON WITHOUT MEALS	S-ATEEN WITH MEALS	S-ATEEN WITHOUT MEALS
BEFORE AUG. 1	□ $100	□ $70	□ $50	□ $30
BEFORE DEC. 10	□ $110	□ $80	□ $55	□ $35
BEFORE JAN. 1	□ $125	□ $95	□ $60	□ $40
WALK-INS	N/A	□ $110	N/A	□ $45
PLEASE CHOOSE FROM THE FOLLOWING MEAL OPTIONS: (Meals included are: Friday dinner, Saturday lunch and Saturday dinner) □ STANDARD □ VEGETARIAN □ KOSHER Please add a $75.00 surcharge for kosher meals
PAYMENT METHOD: □ CHECK □ MONEY ORDER □ CREDIT CARD AMOUNT BEING PAID$________________________________ PLEASE MAKE CHECKS AND MONEY ORDERS PAYABLE TO: SANIC MAIL REGISTRATION WITH PAYMENT TO:SANIC / P.O. BOX 158746, NASHVILLE, TN 37215-8746
CREDIT CARD BILLING INFORMATION, PLEASE COMPLETE ALL ITEMS: CARD BEING USED: □ VISA □ MASTERCARD □ DISCOVER CARDHOLDER NAME:_______________________________________________ BILLING ADDRESS________________________________________CITY_________________ STATE/COUNTRY_____________ZIP/POSTAL CODE ___________SECURITY CODE____________ CREDIT CARD NUMBER:_______________________________________EXP. DATE___________ SIGNATURE:____________________________________________________________