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2025 Virtual NERAASA

Friday - Saturday - Sunday

February 21, 22, 23, 2025

Registration fee: $35

Virtual Registration Form

Printable Registration Form (English)

Printable Registration Form (Spanish)

2025 Virtual NERAASA Registration

February 21-23, 2025

Registration fee: $35

ATTENDEE INFORMATION

About Your Email Address

NOTE: 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*

First

Last

Virtual Badge Name (or Nickname)*

First

Last Inital

Phone Number*

Your Mailing Address (If Canada, change country first.)*

Street Address City State / Province / Region Postal / Zip Code Country (US or Canada)

ACCESSIBILITIES NEEDS

I will require the following services: (Check all that apply)

ASL

Spanish Translation

Please specify other accessibility needs here.

SERVICE INFORMATION

Select your area

Area 11

Area 12

Area 13

Area 28

Area 29

Area 30

Area 31

Area 43

Area 44

Area 45

Area 47

Area 48

Area 49

Area 50

Area 59

Area 60

Area 61

Area 70

Other

If other,, please input your area number

In which state, region or province is your area located?

CURRENT SERVICE POSITION

GSR/ Alternate GSR

DCM/Alternate DCM

DCMC/Alternate DCMC

District Committee

Area Committee

Area Officer

Delegate

Alternate Delegate

Past Delegate

Central Office/Intergroup

Other

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 Communities

Please press "SUBMIT" button only once.

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