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Registration Form
Women's Recovery Workshop 2024

 

Early Bird Registration $145 Until March 1, 2024
Regular Registration $155 After March 1st Through March 12, 2024

Full Name

________________________________________________________________________________________________

Address: City, State, Zip

________________________________________________________________________________________________

Phones                                                Email

________________________________________________________________________________________________

Can we email you for further notices and confirmation?  Yes_____    No_____

Have you attended before?  Yes_____    No_____

What 12 step program(s) have you attended before?

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

Your sober/clean date ____________________

 

Are you elderly and need a bottom bunk?  Yes_______  No______

Bottom bunks are first come first serve, and must be requested.  If you can take an upper bunk, please do.

If there's room, I'd l ike to share a cabin with:_______________________________________________________

Make checks payable to: Women's Recovery Workshop

Mail to:

Women's Recovery Workshop
C/O Chris Langford
575 Concord Road
Apartment 2101
Jefferson, GA 30549

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