PRE REGISTRATION DEADLINE IS NOV 30th, 2008

REGISTRATION (PLEASE WRITE CLEARLY)
MAIN ATTENDEE (All fields are requested)
LAST NAME
:
FIRST NAME
:
MIDDLE NAME
:
ADDRESS     -      CITY
:
DISTRICT
:
ZIP/POSTAL CODE
:
COUNTRY
:
E-MAIL
:
PREFERRED METHOD OF COMMUNICATION :
E-MAIL
MAIL
PHONE
     
BADGE TYPE (CHECK ONE) :
1) AA   2) ALANON
3) ALATEEN   4) FRIEND/SPOUSE
                   
FIRST INTERNATIONAL CONVENTION :
YES NO
 
 
 
YEARS OF AA MEMBERSHIP
:
 1 YEAR OR LESS 1-3 YEARS
    4-10 YEARS 11-20 YEARS
    OVER 20 YEARS    
           
AGE GROUP : 13-15 YEARS 16-25 YEARS
    26-39 YEARS 40-55 YEARS
    56-65 YEARS OVER 65 YEARS
 
     
     
 

REGISTRATION (PLEASE WRITE CLEARLY)
MAIN ATTENDEE (All fields are requested)
LAST NAME
:
FIRST NAME
:
MIDDLE NAME
:
ADDRESS     -      CITY
:
DISTRICT
:
ZIP/POSTAL CODE
:
COUNTRY
:
E-MAIL
:
PREFERRED METHOD OF COMMUNICATION :
E-MAIL
MAIL
PHONE
     
BADGE TYPE (CHECK ONE) :
1) AA   2) ALANON
3) ALATEEN   4) FRIEND/SPOUSE
                   
FIRST INTERNATIONAL CONVENTION :
YES NO
 
     
 
YEARS OF AA MEMBERSHIP
:
 1 YEAR OR LESS 1-3 YEARS
    4-10 YEARS 11-20 YEARS
    OVER 20 YEARS    
           
AGE GROUP : 13-15 YEARS 16-25 YEARS
    26-39 YEARS 40-55 YEARS
    56-65 YEARS OVER 65 YEARS
 
     
  PAYMENT  
     
 
CREDIT CARD : PLEASE CHARGE MY CREDIT CARD
   
VISA CARD: MASTER CARD: OTHERS:
    CARD NO:
    EXPIRATION DATE:
    CARDHOLDER NAME:
       
     
 
     
  ALL PAYMENTS TO BE MADE PAYABLE INTO - AA INTERNATIONAL CONVENTION - KARNATAKA
A/C NO. 077010100232234 - AXIS BANK		  
     
   
     
  IMPORTANT  
     
 
Each Person who registers for the 2009 International Convention is responsible for having the proper documentation and proof of citizenship they need for themselves in order to come to India and back to the respective home countries. By registering, you acknowledge you understand and accept this responsibility. The Organizer will not be responsible for fines, fees, deposits or fares charged or forfeited as a result of failure to comply with all appropriate Indian laws regarding border crossing. Information regarding requirements for India visa travel can be found on the internet or by contacting the Indian Embassy.
 
     
 
 
 
 
 
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