REGISTRATION FORM
Please fill out the details below and post to:
QYPAA CONVENTION 2005 PO Box 2232 Milton BC QLD 4064 Australia
Email: mail@qypaa.org
Website: www.qypaa.org
Telephone: Richard (07) 3818 0180 or Craig 0405 326 690
Name:
Address:
PostCode:
Phone:
Email:
Home Group:
Sobriety Date:  AA  Al Anon
Age:  20-less  21-40  41-60  61+
Available to Speak:  Yes  No
Available for service:  Yes  No
REGISTRATION OPTIONS (all prices include GST)
A$- Full *Conc.
Early Bird Weekend - includes dance $38 $32 $   (Avaliable until 30 June)
Weekend Registration - includes Dance $45 $38 $
Friday Registration $10 $10 $
Saturday Registration - includes Dance $25 $25 $
Dance Only $5 $5 $
Sunday Registration $20 $20 $
Sunday Breakfast Meeting - City Gardens Café $20 $20 $
Total $
*Concession includes pensioners, students, unemployed
METHOD OF PAYMENT
Make payable to: QYPAA
Cheque  Money order  Bankcard  Mastercard  Visa
Cardholders Name:
Cardholders Signature: Exp Date: /
(confirmation of payment will be mailed to you.)
Copyright © QYPAA 2005 Disclamer