Full Name
*
First Name
Last Name
Name to Print on Badge
*
This is the name that will be printed on your convention badge.
E-mail
*
example@example.com
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Old Timer: Have you had 20 years or more of continuous sobriety?
*
Yes
No
Old Timer (ONLY): Will you be attending the Old Timers' Luncheon on Saturday? There is no cost but we do need a head count.
*
Yes
No
Please select all that apply
*
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Pre-Register for Convention
Deadline to Pre-Register is October 17, 2025
$
25.00
Scholarship
Help lend a hand to those who are unable to pay the registration fee.
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Make an Additional Donation
Please consider making an additional donation to help with convention expenses.
$
1.00
Donation Amount
Quantity
Price
$1
1
2
3
4
5
6
7
8
9
10
$
1.00
$5
1
2
3
4
5
6
7
8
9
10
$
5.00
$10
1
2
3
4
5
6
7
8
9
10
$
10.00
$20
1
2
3
4
5
6
7
8
9
10
$
20.00
$50
1
2
3
4
5
6
7
8
9
10
$
50.00
$100
1
2
3
4
5
6
7
8
9
10
$
100.00
Pre-Order SHORT SLEEVE T-shirt
Deadline to pre-order shirt is October 17, 2025. Shirts will be available for pickup at the Convention.
$
25.00
Size
Color
Quantity
Price
S
Select
Green
Purple
1
2
3
4
5
6
7
8
9
10
$
25.00
M
Select
Green
Purple
1
2
3
4
5
6
7
8
9
10
$
25.00
L
Select
Green
Purple
1
2
3
4
5
6
7
8
9
10
$
25.00
XL
Select
Green
Purple
1
2
3
4
5
6
7
8
9
10
$
25.00
2XL
Select
Green
Purple
1
2
3
4
5
6
7
8
9
10
$
30.00
3XL
Select
Green
Purple
1
2
3
4
5
6
7
8
9
10
$
30.00
4XL
Select
Green
Purple
1
2
3
4
5
6
7
8
9
10
$
30.00
Pre-Order LONG-SLEEVE T-shirt
Deadline to pre-order shirt is October 17, 2025. Shirts will be available for pickup at the Convention.
$
30.00
Size
Color
Quantity
Price
S
Select
Green
Purple
1
2
3
4
5
6
7
8
9
10
$
30.00
M
Select
Green
Purple
1
2
3
4
5
6
7
8
9
10
$
30.00
L
Select
Green
Purple
1
2
3
4
5
6
7
8
9
10
$
30.00
XL
Select
Green
Purple
1
2
3
4
5
6
7
8
9
10
$
30.00
2XL
Select
Green
Purple
1
2
3
4
5
6
7
8
9
10
$
35.00
3XL
Select
Green
Purple
1
2
3
4
5
6
7
8
9
10
$
35.00
4XL
Select
Green
Purple
1
2
3
4
5
6
7
8
9
10
$
35.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
ACH Bank Transfer
Submit
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