2018 Southwest Regional Convention Registration Form

2018 CA SOUTHWEST REGIONAL CONVENTION

REGISTRATION FORM

“CA 2018 Annual Southwest Regional Convention”

April 20 - April 22, 2018
Westin Dallas Park Central Hotel
12720 Merit Drive
Dallas, Texas 75251

Hotel Registration can be completed by going to the link on the CA North Texas website please, or by calling the Hotel (at 972-385-3000) and asking for reservations and tell them you are a part of the CA 2018 Regional Convention starting on April 20, 2018

ON LINE REGISTRATION HAS CLOSED, PLEASE REGISTER ON SITE NOW, SEE YOU NEXT WEEKEND!

"Recovered, We Are"

Today's date * +

Sobriety Date * +

Last Name: *

First Name *

Address *

City *

State *

Country - please insert only if not the US

Zip/Postal Code *

Mobile Phone *

How would you like your name badge to read please, insert the equivalent of only two lines of text please (optional)

Region *

Area Represented (If you don't know or aren't sure of this, please just put what State you are from) *

Email *

Please Choose One: *

Regular Registrant

Delegate

Alternate Delegate

Area Chair

Would you like to lead a 12-Step meeting at the Convention? *

Yes

No

Would you be willing to do service at this year's Convention? *

Yes

No

If you have any special needs please let us know in the space indicated here.

Will you be staying at the Hotel? *

Yes

No

If Yes, rooming with:

Dates You Are Staying at the Convention Hotel?

	Thursday April 19		Friday April 20		Sat April 21		Sunday April 22
	Yes	No		Yes	No		Yes	No		Yes	No
check yes or no please for each day	Yes	No		Yes	No		Yes	No		Yes	No

Please use the section below for the Convention events and total registration fees!

Please note that the Registration Fee is a suggested donation, all other charges are requred.

Please put quantity (number) in the boxes below for each item you would like to purchase! If you opt for any of the packages, you will not need to separately select any of the A la Carte items (registration, banquet, brunch and entertainment). Once you are finished with your selections, please hit "calculate" to see the balance due! Note please, if there is no value for you to insert into the empty box, please insert zero in that box. *

	Early registration is closed now
	Premium Convention Package Regular (Registration on ine is closed now, please register on site), banquet, brunch, all entertainment (both nights) through April 10, 2018) $109.00
	Premium Convention Package Late and on-site (please regiser on site now, online registation is closed)Registration, brunch, banquet, all entertainment (both nights); after April 10, 2018) $120.00
	Registration Fee early- not available now
	Registration Fee (Suggested) Regular through April 10, 2018 this is now closed, please register on site$30.00
	Registration Fee (Suggested) deadline for on line has passed please register on site)
	Convention T-shirt ($15.00) indicate size below please
	Banquet Buffet early registration, not available now
	Banquet Buffet Saturday Regular through April 10, 2018 $50.00
	Banquet Buffet Saturday Late and on-site After April 10, 2018 $55.00
	Sunday Spiritual Breakfast buffet early registration pricing is no longer available
	Sunday Spiritual Breakfast buffet regular through April 10, 2018 $30.00
	Sunday Spiritual Breakfast buffet late and on-site after April 10, 2018 $35.00
	Entertainment on Friday night $10.00
	Entertainment for Saturday night $10.00
	Donation for the newcomer (Whole number only, please; i.e. put "10" for $10.00)
	Scholarship for a newcomer (Whole number only, please; i.e. put "20" for $20.00)

Total

$0.00

Special Banquet Buffet with Salmon and Chicken, salad, potato, vegetables, rolls and coffee/tea) - select Salmon/Chicken Buffet or Vegetarian please so that we can plan accordingly

Salmon/Chicken Buffet

Vegetarian

Men's T-shirt or Women's T-shirt

Men's T-shirt

Women's T-shirt (no longer available to order)

T-shirt Size

You may make your payment by check, money order, or credit card paypal.

Please do not mail cash.

After you complete the form, you will hit submit which will then take you to the payment page.

Please also note that the ability to register by check or money order ends on March 20, 2018.

Payment Type *

Credit Card Payment see next page for more detail on this option please - Note please that you can pay with a credit card as a Paypal Guest

Check and money order payment see next page for more detail on this

Scholarship requested please (Note: for those who might otherwise be unable to attend, scholarships for basic registrations may be available to help make attending the Convention more affordable)

paypal payment - see next page please for more detail

E-Signature Authorization: By submitting this form, I represent that the information submitted is correct and I authorize the credit card to be charged in the amount detailed above If appicable. *

yes - I agree

ALL registration forms need to be completed April 10, 2018 or on site thereafter.

If you have any questions at all, please reach out to Vicki R., our Registation Chair, she can be reached at 214-478-3931 or by email at bnvrosamond87@aol.com

We look forward to seeing you. Thank you for joining us for this surely-to-be-memorable Convention!

Southwest	Atlantic North	Atlantic South
Midwest	Pacific North	Pacific South
European	Unknown