World Service Conference

25 April—1 May 2004

Conference Registration & Housing Form

All regional delegates and alternates must complete this form.

You may fill out the form here or download it and then mail or fax it to NAWS.

Registration forms must be completed no later than 15 March 2004.

Name of your region:

I am the:

Regional Delegate
Alternate Delegate

Contact Info.:

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Arrival Date:

-- mm/dd/yy

Departure Date:

-- mm/dd/yy

Check One:

Smoking Room
Non-Smoking Room

I require an ADA-Compliant Room:

Special Requests:

I know who my roommate is. Please make sure your roommate completes a reservation form as well. If you (or your roommate) are not being funded by NAWS, you will be asked for a form of payment for your half of the room expense ($54.20 per night, tax included) upon arrival to the Warner Center Marriott. Please provide us with the name of your roommate:

First Name
Last Name

I need a roommate:

If you have not completed this form online, please mail it to NA World Services, c/o WSC Traveler, 19737 Nordhoff Place, Chatsworth, CA 91311 or fax it to 818.700.0700.