REGISTRATION FORM
COMPLETE THIS FORM AND MAIL TO:
ROCK MOUNTAIN GATHERING
160 STAYMAN DRIVE
ROSWELL GA 30075
(Please Print Clearly)
Name – Guest 1 ___________________________________AA____Al-Anon_____Alateen____
Name – Guest 2____________________________________AA____Al-Anon_____Alateen____
Address________________________________________________________________
City________________________________________State___________Zip_____________
Telephone
(Home)______________________________Cell_______________________________
Email Address___________________________________________________________
Name on Badge
Name on Badge
Guest 1_______________________________________________
Hometown or Homegroup
Guest 2_______________________________________________
Hometown or Homegroup
Registration fee is $25.00 per person. Make your check payable to Rock Mountain
Gathering
My check in the amount of $______________ for _________people is enclosed.
Place an X here if Guest 1 would like to read at a meeting_________________________
Place an X here if Guest 2 would like to read at a meeting________________________
RESERVATION DETAILS
Place an X as to how you would prefer to receive your registration confirmation and
room reservation instructions:
Via Home Phone # _____________________Via Cell# ______________________
Via Email Address____________________________________________________
(Please Print Clearly)
How many rooms will you need_______________Double_______________Single
If you don’t need a room, but will attend, place an X here_______________________
How many in your party_______________________________________________
Arrival Date__________________Departure Date__________________________