Fellowship of the Spirit South 2012

EARLY REGISTRATION ENDS DECEMBER 15, 2011

Registration Form

Please complete the information below. Once your card has been charged, we will send you a receipt by email. This can take a couple of days. Thank you for registering.

All transactions are SSL protected! This protects your information during and after the transaction.

First Name *
Last Name *
Address Street 1 *
Address Street 2
City: *
State *
Zip Code *	(5 digits)
Cell Ph # *
Landline Ph #
Email *
Name on to appear on Badge *
City & State to appear on Badge *
Attended FOTS South before	YES
Fellowship	AA Al-Anon Guest
Registration $30	REGISTRATION ($30)
Scholarship (MUCH APPRECIATED)	$30 $60 $100
T-Shirts $15	XS S M L XL
T-Shirts large sizes $20	2XL 3XL 4XL
TOTAL to charge *
Card Type
Card # (no spaces please) *
Expiration Month
Expiration Year
Special Needs (please state in comments)	Special Needs
Comments:	Enter comments here!

You will NOT get an immediate receipt when you click "SUBMIT." A receipt will usually follow within 48 hours.

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EARLY REGISTRATION ENDS DECEMBER 15, 2011