| WRW SCHOLARSHIP
Registration Form (Must be postmarked by the Deadline for Scholarship Registration) |
|
|---|---|
| Fill out this registration
form on the screen and print it out or print it out and fill it out by hand. |
|
| YES NO |
Is this your first WRW Scholarship? |
| YES NO |
Have you attended before? |
| YES NO |
Has your address changed since your last worksop? |
| YES NO |
Will you arrive in time for dinner Friday at 5:30pm?? |
| YES NO |
Are you willing to speak or lead a workshop? If yes please include phone number below. |
| Name | |
| Address | |
| City/State/Zip | |
| Phone | (optional) |
| Sobriety Date Al-Anon Date Other Date |
|
| Cabin Preferences |
Choose one: Smoking No Smoking Doesn't matter Choose one: Late Nite Early to Bed Doesn't matter |
| Special Needs: | |
| I contacted
who is a member of the Scholarship Committee. She approved my scholarship and I agreed to pay .00 (which is NON-REFUNDABLE) toward the $75.00 Full Registration Fee. Applications that do not include the agreed to amount will not be accepted. |
|
| Make check or money order
payable to and mail to: WRW 403 Tree Crossing Parkway Hoover, AL 35244 |
|