Registration Information Form

     Name:_______________________________ Volunteer:_______

       Address:__________________________________

       City:  _________________________      State: ______________

       Postal Zip Code: __________ Phone Number:  (_____) - ______-___________  

                                    E-Mail Address ________________________________

                                                                                                                                                   

                             Pre-Registration before (early) 2/15/2018  $ 20.00 after 02/15/2018 $ 25.00

                                                            Make Checks to:  Steps To Sobriety 

                                    Mail Checks - Steps To Sobriety 3001 Karen Ave Largo Florida 33774