www.neraasa.org 2025 Virtual NERAASA Friday - Saturday - Sunday February 21, 22, 23, 2025 Registration fee: $35 Home About NERAASA Agenda/Program Virtual Registration Form Printable Registration Form (English) Printable Registration Form (Spanish) ATTENDEE INFORMATIONAbout Your Email AddressNOTE: For security purposes, the email address you provide will be required to authenticate your admittance to the conference. Please keep a record of the email address you are using for registration. Email Address* Email confirmation* Your Name*FirstLast Virtual Badge Name (or Nickname)*FirstLast Inital Phone Number* Your Mailing Address (If Canada, change country first.)* Street Address City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo (Brazzaville)Costa RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe Country (US or Canada)ACCESSIBILITIES NEEDS I will require the following services: (Check all that apply)ASLSpanish Translation Please specify other accessibility needs here.SERVICE INFORMATION Select your areaArea 11Area 12Area 13Area 28Area 29Area 30Area 31Area 43Area 44Area 45Area 47Area 48Area 49Area 50Area 59Area 60Area 61Area 70Other If other,, please input your area number In which state, region or province is your area located? CURRENT SERVICE POSITIONGSR/ Alternate GSRDCM/Alternate DCMDCMC/Alternate DCMCDistrict CommitteeArea CommitteeArea OfficerDelegateAlternate DelegatePast DelegateCentral Office/IntergroupOther If not listed, please indicate your A.A. service position and a brief description below: ROUNDTABLES (Please select the roundtable(s) you plan to attend)Accessibilities / Remote CommunitiesArchivesArea Chair / Alternate Area ChairsCooperation with the Professional Community (CPC)CorrectionsArea Delegates / Alternate Area DelegatesDistrict Committee Members (DCMs) / Alternate DCMs/District Committee Member Chairs (DCMCs) / Alternate DCMCsGeneral Service Representatives (GSRs) / Alternate GSRsGrapevine / La ViñaIntergroup and Central Offices LiteraturePublic Information (PI)RegistrarsSecretariesTreasurersTreatmentWebsites / TechnologyYoung PeopleEspanolPAST DELEGATE INFORMATION Area Number Panel Number Conference Committees Are you willing to moderate a roundtable?YesNoSERVICE AT NERAASA Please check all that applyI am a first time NERAASA attendeeI have been a past NERAASA Presenter.I am interested in being a Presenter.I have been a past Panel Moderator.I am interested in being a Panel ModeratorI would like to participate in a panel discussionI am interested in a Tech Volunteer opportunity (security/timer)I am a Spanish speaker and would like to present in Spanish as a NERAASA PresenterPAYMENT INFORMATION Registration Fee* USD Credit Card Information Name* Country* Zip code*Please press "SUBMIT" button only once.SubmitReset
