MMAAC 12 Registration Form
(Please print and mail)

Friday, June 22nd thru Sunday, June 24th, 2012

Pre-Registration must be postmarked on or before June 12th, 2012
For the Pre-Registration Fee of $35

After June 12th, Register On-site. Weekend Fee is $40 per person
Walk-up One-Day-Only Fee is $20
(13-17 yrs old  1/2 price, 12 and under free, Please let us know how many.....)

MMAAC 12 (2012) Online Printed Registration Form -Please Print Clearly

Name                                                 Name on Badge                                                

Address                                                                                                                   

City, State, Zip                                                                                                         

E-mail address                                                                                                         

AA           Al-Anon           Other           Sobriety Date                /             /                 

Would you like to chair a meeting?  Yes        No          If Yes, Phone #           -        -              

Hearing Impaired or Other Special Needs (Specify)                                                                

Number of children accompanying aou                     ages                                                       

Enter number of Pig Roast Dinners for Saturday Night            (Include $5.00 for each)

Total Amount Paid                                   

Print and mail with checks made out to:

MMAAC
P.O. Box 8925
Rockford, IL 61126

Note: No confirmation will be sent