sd The Long Island Round Up June 11, 2010 - June 13, 2010 For a print-friendly version of this form, click here
First Name *
Last Name *
E-mail *
Phone Number *
Address *
City *
State *
AA Recovery Date
ALANON Serenity Date
Country *
Would you like to chair a workshop?	Yes No
Workshop suggestions
LIRU Registration	Early Early Registration asdfa (postmarked on or before 02/15/10) ($30.00) Early Registration asdfa (postmarked between 02/16/10 and 04/15/10) asdfaa($40.00) Regular Registration sdfgs (postmarked between 04/16/10 and 06/10/10) asdfaa($50.00) Registration at the Roundup ($55.00) The Play Only 06/12/10 at 3:45 PM ($15.00) The Dance Only 06/12/10 at 10:00 PM ($15.00) Total : $0

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