Registration | Space Coast Round Up

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Cost of Registration: $30.00/person

Details for check-in and a schedule for the event will be sent out when available

Select the ‘Paypal’ button after filling out the required information to complete registration by submitting payment.

Registration is not complete until a payment confirmation email and an email confirming registration information is received. (Please check your junk/spam folders for the email if it doesn’t show up)

A Paypal account is NOT required, but a valid credit/debit card is.

Please contact the Brevard Intergroup office at (321)-724-2247 with any questions, or to register in person.

Number of Registrations

Full Name (required)

Badge Name (required)

Address (required)

City (required)

State (required)

Zip (required)

Phone (required)

Email (required)

Sobriety Date

Home Group

Accessibility Requirements Needed?

Are you willing to volunteer? YESNO

Registration Type
AAAL-ANON

Select to Display Second Registration Information (required)

Second Registration
Full Name (required)

Badge Name (required)

Address

City

State

Zip

Phone

Email (required)

Sobriety Date

Home Group

Accessibility Requirements Needed?

Are you willing to volunteer? YESNO

Registration Type
AAAL-ANON

Select to Display Third Registration Information (required)

Third Registration
Full Name (required)

Badge Name (required)

Address

City

State

Zip

Phone

Email (required)

Sobriety Date

Home Group

Accessibility Requirements Needed?

Are you willing to volunteer? YESNO

Registration Type
AAAL-ANON

Select to Display Fourth Registration Information (required)

Fourth Registration
Full Name (required)

Badge Name (required)

Address

City

State

Zip

Phone

Email (required)

Sobriety Date

Home Group

Accessibility Requirements Needed?

Are you willing to volunteer? YESNO

Registration Type
AAAL-ANON

© Space Coast Round Up 2018