Registration

If paying with credit card, print this form, fill it out and fax it to: (210) 493-3946
If paying by check: Print this form, fill it out, include a check made payable to Chairman, Weekend in S.A., and mail the form and check to:

Chairman, Weekend in S.A.
8919 Wickfield
San Antonio, Texas 78217-4141

Name: ___________________________________
Name: ___________________________________
Address: ___________________________________
City, State, Zip: ______________________________
Email Address _____________________________
Badge Name: ____________________ ___ AA or ___ Al-Anon
Badge Name: ____________________ ___ AA or ___ Al-Anon
Pre-Registration $___________ $20.00 per person ($5.00 savings)
Door Registration $___________ $25.00 Per Person
Scholarship $_________ Donation
Dance: $__________ $5.00 per person
TOTAL: $__________
Paying By: ____ Check ____ Credit Card
___ Visa ____ MC ____ AmEx
___ Discover ____ Diners ____ Carte Blance
Type or Print Card Member Name: ___________________________________
Type or Print Card # __________________ Exp. Date: ______
Signature: ___________________________________