Form - Alcoholics Anonymous Aotearoa/New Zealand

Title

First Name*

Last Name*

Address*

Street Address Address Line 2 Town/City Post Code Country

Contact Number*

Email*

Preferred name on badge*

Organisation*

AA
Al-Anon
Alateen
Other

Are you a GSR - Group Service Representative?

Yes
No

How many years of sobriety do you have?

Do you have a vaccine pass? (if required)

Yes
No

Will you be flying to Nelson?

Yes
No

Will you require an Airport transfer to Teapot Valley?

Yes
No

Registration type: Weekend or Day*

Full Weekend Special $139.50 / person (w/meals incl)
Basic Registration $25.00 / person

Accommodation Type*

Bunk bed in shared cabin
Powered Camp Site
Unpowered Camp Site

Please bring your own linen (towel, bedding, pillow).

Accommodation Type*

Bunk bed in shared cabin $45/person/night
Powered Camp Site $45/person/night
Unpowered Camp Site $40/person/night
None

Please bring your own linen (towel, bedding, pillow).

Linen hire

Yes - $25.00 (Linen hire - weekend rate)
No

Linen hire

Yes - $25.00 (Linen hire - weekend rate)
No

Book Accommodation - Bunk Bed

Friday night
Saturday night
Both nights
None

Per person per night rates

Book Accommodation - Powered camp site

Friday night
Saturday night
Both nights
None

Per person per night rates

Book Accommodation - Unpowered camp site

Friday night
Saturday night
Both nights
None

Per person per night rates

Book Friday dinner*

Yes Friday meal $20
No

Book Saturday dinner*

Yes Saturday meal $20
No

Number of additional people

Please enter a number less than or equal to 10.

Additional people cost

Price: $ 0.00

List additional people*

Name	Town/City	GSR	Preferred name on badge	Contact number	Organization	how many years of sobriety	Vaccine Pass (Yes/No)

Please tell us about any special dietary needs, allergies or other requirements

Total

$ 0.00

I agree to the terms and conditions*

Yes - Terms & Conditions

Read the terms and conditions

Payment method*

Bank Transfer

Please make your payment directly into our bank account. Please use your name as the payment reference.

Bank name

Kiwibank

Account name

SAA HPC

Account number

38-9023-0478630-00

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