Kansas Area Cocaine Anonymous

12 Step recovery from cocaine and all other mind altering substances.

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Kansas Area Convention 2021

October 1 – 3, 2021

BEST WESTERN WICHITA NORTH
915 EAST 53RD STREET NORTH, WICHITA, KS 67219

Mail In Registration: Download Convention Registration 2021

2021-Kanasa Area Convention Registration

Name *

Email

Phone

Address *

City *

State *

Zip *

Area / Group

Name as you would like it to appear on your badge:

Early Registration - Before 09-01-2021

ALL-IN! (includes a T-Shirt) - $90 (Please choose a shirt size)

Small - T-shirt

Medium - T-shirt

Large - T-shirt

XL

XXL

XXXL

Total Early Registration $

Packages - À la carte

Basic Registration: $30

Sat. Night Banquet: $30

Fr. Night Entertainment $10

Total À la carte Package Amount $

Memorabilia - T-Shirts - $25

Small

Medium

Large

X Large

XXL

XXXL

Total T-Shirts Amount $

Total Amount Payable - When you submit this form, you will be redirected to our paypal account for payment.

Comments, Notes, Special requests

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Online Registration: Click Here!

Mail In Registration: Download CA-Kansas-Convention-Registration-2021-pamplet

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