WEB REGISTRATION FORM – 2010 CoDA WEEKEND

 Make checks payable to “CoDA Weekend” and mail with this form to:

CoDA Weekend Registration

1375 Byberry Road

Huntingdon Valley, PA   19006

Name:__________________________________________    Registration Fee

Address:_______________________________________________________     $200.00

City, State & ZIP:_______________________________________________

                                                                                                         

Phone #:______________________________________                            Amount Enclosed: **

E-mail Address:______________________________ ***                          $__________________      

***By providing my email address, I  consent to be contacted by the Philadelphia Area CoDA Intergroup with information about upcoming CoDA events or fellowship news.

Home CoDA Group:______________________________________                                        

Please list person(s) you wish to room/cabin with:    ---------------------------------------------

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**If electing non-refundable deposit option, please enclose $100.00.  Balance of $100.00 must be paid by 5/15/09. 

      ($25.00 Service Fee on all refunds)

 

Please circle T-shirt size preference:      S    M    Lg    XLg    XXLg

(T-shirt size preference may not be available for those who register after April 30th,, 2010)

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 Please use a separate registration form for each person attending the Weekend