2012 Online Registration is Now Open!

On-line Registration & Payment

This registration form is your on-line "envelope". This form can be used to register up to 10 people at a time. The seat limit per table is 10.

To Add a person to this on-line "envelope", fill out the form and press add.


On-Line Envelope Registration Form
NOTE: Fields marked with a * are required.
* First Name:

First name is required.
* Last Name:

Last name is required.
* Address 1:

Address 1 is required.
Address 2:
*City:

City is required.
* State:

State is required.
* Zip:

Zip is required.
* Phone:

Phone is required.
* Email Address:

Last name is required.
Register For: (regular price after Jan 1st 2012)
Banquet and Conference - $50.00
Conference Only - $20.00
Attendee Type:

Attendee Type is required.
 AA
Young AA
Al-Anon
Alateen
Guest
Guest (Under 8)
Special Needs: Wheel Chair
Vegetarian Meal
Hearing Impaired
Blind
Gluten Free
Diabetic

Other Information:
1st Year at a NIA Conference
Change of Address



Users in this on-line envelope:

This enveloped is currently empty



Off-line Registration & Mail-in Payments

Prefer to mail in your registration?

If you prefer not to make a payment online then please register by printing and filling out the registration form and mail your form plus a check made payable to "2012 NIA Spring Conference" to:

2012 NIA Spring Conference
Box 995
Bourbonnais, IL 60914