SSAASA 8 Registration FormRegistration Fee: $35.00
Registration begins December 9, 2024.
Name:
Name For Badge:
Area#
City:
State: AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip:
Phone:
Email:
Do you have any accessibility or special needs during the event?:
Preferred method of communication: CallTextEmail
Current service position:
Past Service Experience: GSRDCMDelegateChairpersonSecretaryTreasurerChairTrusteeGSO StaffTreatmentCorrectionsPICPCAccessibilitiesArchivesLiteratureGrapevine
I would like to be contacted about volunteer opportunities at SSAASA 8
I would like to contribute to the SSAASA scholarship fund to help others attend.
Contribution total:$
I would like to add the $1.71 Paypal fee to my total.
Paying by check? Make all checks out to:
SSAASA Steering Committee PO BOX 2694 Woodbridge VA 22195
Click Here to Download Form
Pay with PayPal
