Personal Information
*Your first name and last initial:
*Home Group:
*Program (SAA/COSA/Other):
*Email address:
(To keep costs down & to increase efficiency, our preference is to use email whenever possible)
*All information on this form is considered confidential and will be used only by the program committee.
Workshop/Panel Information
Proposed title of workshop or panel:

Please describe your subject and how the workshop will benefit the participants' recovery.
(Examples: "Action in Recovery" (2011 theme), 12 Steps, Tools of the Program, Sponsership.)

Preferred length: 1 Hour 1.5 Hours 2 Hours None

Preferred date & time:
Friday Morning Friday Afternoon None
Saturday Morning Saturday Afternoon

Provide a desciption of your workshop, as you would like it to appear in the program:

Would you prefer your workshop/panel is:
Closed (SAA or COSA members only). Please indicate which program: 
Open (for all attendees of the retreat)
For a specific group (gender, orientation, newcomer focus, etc.)   Define: