Alateen 2026 Convention Registration Form

ALATEEN Registration for 51st Annual NC/Bermuda Al-Anon/Alateen Convention Feb 27-March 1, 2026

At the Village Inn in Clemmons, NC. Hotel reservations can be made at the group rate. Breakfast is included with hotel room booking!
All registrants must complete the downloadable Medical/Travel Authorization Form and email to:

Alateen@ncbermudaafg.org

To pay by check, also complete the downloadable Registration Form. Mail the registration form with check to:

NC Bermuda Convention, Attn: Fatima Khastkhoda, PO Box 98211, Raleigh, NC 27624

Alateen Registration Form & Medical/Travel Authorization Form
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Name on Badge
E-mail*
Alateen Specifics:
Age
for Alateens only
Gender
for Alateens only
Alateen Group Name
Alateen Group City
Alateen Group State
NC for example
TRANSPORTATION (Person transporting you to and from Convention)
Transportation Contact
Person transporting you to and from convention
Phone number for Transportation Contact

Area CodePhone Number
Parent/GuardianAMIASSelf
FOR PARENT/GUARDIAN (If transporting Alateen to Convention)
I am staying for the entire Convention and my child will be under my care at all times.I am leaving my child in the care of an AMIAS for all/part of the Convention. If registering onsite please be sure to complete the NC Alateen Medical Information and Travel Form.
About your Alateen Sponsor or Assisting AMIAS
Your certified AMIAS/Sponsor for the weekend must be same gender as you. If you cannot arrange for a Sponsor of the same gender, please contact the Area Alateen Coordinator at alateen@ncbermudaafg.org so that one can be assigned to you for the Convention.
AMIAS or Alateen Sponsor

First NameLast Name
AMIAS or Alateen Sponsor Phone

Area CodePhone Number
Other Important Stuff
YesNo
Signature of Parent/Legal Guardian: I authorize my child to attend the NC/Bermuda Al-Anon/Alateen Convention
Parent / Legal Guardian Name

First NameLast Name

My Products

Registration Fee $10.00

Donation$1.00

Dollars

Enter coupon

Total $0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

ALATEEN Registration for 51st Annual NC/Bermuda Al-Anon/Alateen Convention Feb 27-March 1, 2026

Alateen Specifics: