VSCYPAA 2023 Registration Form

Please complete the following form to register for VSCYPAA 2023. The registration fee is $10, which can be paid via Venmo at the conclusion of this form, is non-refundable. If you have any questions, please email our registration chair directly at sarah.vscypaa23reg@gmail.com !

First Name:

Last Name:

Email Address:

Phone Number:

City you are attending from:

State you are attending from:

Sobriety Date:

Please confirm whether you are registering to attend or donating a scholarship.

* At $10 per 1 registration

Amount