Serenity by the Sea VCAA Round Up
Online Registration Form
THIS FORM IS FOR REGISTRATIONS OF 4 OR LESS AND INCLUDES THE OPTIONS TO ATTEND THE AA BBQ AND/OR AL-ANON LUNCHEON.
NO CHECKS WILL BE ACCEPTED USING THIS ONLINE FORM. IF YOU NEED TO WRITE A CHECK, PLEASE PRINT & MAIL IN THE MANUAL FORM.
Primary Registrant: (additional registrants can be entered later in this form)
Guest 1 First Name
*
Guest 1 Last Name
*
Mailing Address
*
City
*
State
*
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
*
Guest 1 Badge Name
*
Affiliation
*
Please Select
AA
AA Committee
Al-Anon
Al-Anon Committee
Alateen
Guest
Guest 1 Group or City for badge
*
E-mail
*
Phone
*
Guest 1 Pre-Registration $15: (Make sure to select "Yes")
*
Please Select
Yes
Guest 1 Meal Preference Saturday BBQ - $12
Please Select
Beef
Chicken
Saturday 4 PM
Ventura Room
Guest 1 Saturday Al-Anon Luncheon- $15: (Make sure to select "Yes")
Please Select
Yes
Saturday 11:30 AM -1:30 PM
Oxnard Room
Calculation
Would you care to donate a registration scholarship for those who cannot afford it? ($20 each)
Enter the quantity being donated. $20 ea.
AA Registration Donation
Please Select
1
2
3
4
5
Enter the quantity being donated. $20 ea.
Al-Anon Registration Donation
Please Select
1
2
3
4
5
Calculation
Do you have any additional guests?
*
Yes
No
Guest registrants can be entered here. Up to 3 additional on this form.
Guest 2 First Name
*
Guest 2 Last Name
*
Guest 2 Badge Name
*
Affiliation
*
Please Select
AA
AA Committee
Al-Anon
Al-Anon Committee
Alateen
Guest
Guest 2 Group or City for Badge
*
Guest 2 Pre-Registration $15: (Make sure to select "Yes")
Please Select
Yes
Guest 2 Meal Preference Saturday BBQ - $12
Please Select
Beef
Chicken
Saturday 4 PM
Ventura Room
Guest 2 Saturday Al-Anon Luncheon- $15: (Make sure to select "Yes")
Please Select
Yes
Saturday 11:30 AM - 1:30 PM
Oxnard Room
GUEST 2 TOTAL
Additional Guests?
*
Yes
No
Guest 3 First Name
*
Guest 3 Last Name
*
Guest 3 Badge Name
*
Affiliation
*
Please Select
AA
AA Committee
Al-Anon
Al-Anon Committee
Alateen
Guest
Guest 3 Group or City for Badge
*
Guest 3 Pre-Registration $15: (Make sure to select "Yes")
Please Select
Yes
Guest 3 Meal Preference Saturday BBQ - $12
Please Select
Beef
Chicken
Saturday 4 PM
Ventura Room
Guest 3 Saturday Al-Anon Luncheon- $15: (Make sure to select "Yes")
Please Select
Yes
Saturday 11:30 AM - 1:30 PM
Oxnard Room
GUEST 3 TOTAL
Additional Guests?
*
Yes
No
Guest 4 First Name
*
Guest 4 Last Name
*
Guest 4 Badge Name
*
Affiliation
*
Please Select
AA
AA Committee
Al-Anon
Al-Anon Committee
Alateen
Guest
Guest 4 Group or City for Badge
*
Guest 4 Pre-Registration $15: (Make sure to select "Yes")
Please Select
Yes
Guest 4 Meal Preference Saturday BBQ - $12
Please Select
Beef
Chicken
Saturday 4 PM
Ventura Room
Guest 4 Saturday Al-Anon Luncheon- $15: (Make sure to select "Yes")
Please Select
Yes
Saturday 11:30 AM - 1:30 PM
Oxnard Room
GUEST 4 TOTAL
TOTAL
TOTAL
Who ordered BBQ-Beef?
Who ordered BBQ-Chicken?
My Products
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next
( X )
Pre-Registration
$
15.00
Quantity
1
2
3
4
Item subtotal:
$
0.00
BBQ - Beef
$
12.00
Quantity
1
2
3
4
BBQ - Chicken
$
12.00
Quantity
1
2
3
4
Al-Anon Luncheon
$
15.00
Quantity
1
2
3
4
Registration Donation
$
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Check Out
Should be Empty: