Alateen 2025 Convention Registration Form

Pay Online for ALATEEN Registration 2025 NC/Bermuda Al-Anon/Alateen Convention March 14-16, 2025

Village Inn—Clemmons, NC Hotel reservations can be made at the group rate. Breakfast is included with hotel room booking!
Sign up to help at the Registration desk

THE DANCE: the coolest outfit you did or didn’t wear to the coolest dance you did or didn’t attend. Ballet? Prom? Plain old-school dance? Kitchen dance? Rain dance? One outfit will win a set of speaker tapes. We officially have a live band to play!
To pay by check please use the downloadable forms:

Al-Anon & AA PDF Registration Form

Alateen Registration Form & Medical/Travel Authorization Form

AMIAS Registration Form
Full Name*

PrefixFirst NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Name on Badge
E-mail*
Alateen Specifics:
Age
for Alateens only
Gender
for Alateens only
Alateen Group Name
Alateen Group City
Alateen Group State
NC for example
TRANSPORTATION (Person transporting you to and from Convention)
Transportation Contact
Person transporting you to and from convention
Phone number for Transportation Contact

Area CodePhone Number
Driver's relationship (Check all that apply):

Parent/GuardianAMIASSelf
FOR PARENT/GUARDIAN (If transporting Alateen to Convention)
Parent or AMIAS staying

I am staying for the entire Convention and my child will be under my care at all times.I am leaving my child in the care of an AMIAS for all/part of the Convention. If registering onsite please be sure to complete the NC Alateen Medical Information and Travel Form.
About your Alateen Sponsor or Assisting AMIAS
Your certified AMIAS/Sponsor for the weekend must be same gender as you. If you cannot arrange for a Sponsor of the same gender, please contact the Area Alateen Coordinator at alateen@ncbermudaafg.org so that one can be assigned to you for the Convention.
AMIAS or Alateen Sponsor

First NameLast Name
AMIAS or Alateen Sponsor Phone

Area CodePhone Number
Other Important Stuff
I have read the NC/Bermuda Al-Anon/Alateen Safety and Behavioral Policies and agree to abide by them during this event. Initial here.
Initials of Alateen
Will you be attending the Alateen dinner on Saturday night?

YesNo
Signature of Parent/Legal Guardian: I authorize my child to attend the NC/Bermuda Al-Anon/Alateen Convention
Parent / Legal Guardian Name

First NameLast Name
My Products
prevnext( X )
Registration Fee $5.00

Donation$1.00

Dollars

Total $0.00
Should be Empty:

Pay Online for ALATEEN Registration 2025 NC/Bermuda Al-Anon/Alateen Convention March 14-16, 2025

Alateen Specifics: