SEMRU 2023 REGISTRATION FORM
Name:__________________________________________________
Name of Participating Alateen Member: ______________________________
Address:________________________________________________
City:______________________________State:_____Zip Code:_______
Tel#:__________________________________________________ Email:__________________________________________________
AA Recovery Date: __________________________________________
Al-Anon Serenity Date: _________________________ ______________
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□ General Admission Registration $50 $_____________
□ Alateen Registration: (Adult accompaniment required for non-Alateen workshops) $5$_____________
□ Jini B. Memorial Scholarship: Requests for scholarship must be sent with a completed registration form with a letter from you and your sponsor stating the reason for your request. All scholarships requiring housing must be submitted before January 31, 2023.
You will be notified soon after our February 2023 meeting.
□ Jini B. Memorial Scholarship contribution: To assist those who may not otherwise attend. $_____________
□ Saturday Lunch Buffet: all-inclusive Qty: _______ x $22.00 $____________
Variety of deli meats and cheese, breads/rolls, tossed green salad, potato salad, coleslaw, lettuce, sliced tomato, onions, pickles, soup, freshly baked cookies and brownies, assorted beverages.
□ Saturday Dinner Buffet: all-inclusive Qty: _______ x $40.00 $_____________
Soup, tossed green/Caesar/pasta salads, rolls, braised sirloin tips, baked scrod w/ritz topping/Florentine cream sauce, chicken w/mushrooms and gravy, vegetarian options, potato/pasta and vegetables, strawberry shortcake w/lemon mousse, coffee/tea/soda.
□Sunday Brunch: all-inclusive Qty: __________ x $40.00 $_____________
Chilled Juices: orange, cranberry, & apples; assorted Danish, fresh baked muffins, bagels & croissants; assorted cold cereals & oatmeal; fresh fruit; Country fresh scrambled eggs, crisp bacon & sausage links, breakfast potatoes; Tri-color rotini pasta salad; Antipasto; seasonal vegetables, mashed potatoes; sliced sirloin/Pot Roast w/gravy; Caprese Chicken w/pesto cream sauce ; assorted desserts; Coffee, decaf & teas.
□ Monday Gratitude Brunch:all-inclusive Qty: _______ x $20.00 $_____________
If meals are not pre-paid (Lunch (Sat), Dinner (Sat), Brunch (Sun)) tickets will be available the weekend of the event with a cutoff date of Feb 17, 2023.
Total enclosed $______________
Special Accommodation: The Holiday Inn is handicapped accessible. There is TTY terminal at the front desk.
I need help with: __________________________________________________
I can help with:___________________________________________________
If you need to request a Sign Language Interpreter, please check here ✎______________
If you would like to perform in Friday night’s Cabaret, please provide contact #:___________________________________________________________
If you would like to be invited to SEMRU’s “Secret” Facebook Page, please check here✎______
Email:_________________________________________________________
Please make copies, share with your friends, or visit www.semru.org
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Pre-Registration options: www.semru.org online via Eventbrite (ONLINE FEES DO APPLY) or mail form to
SEMRU
P.O. Box 505
Mansfield MA 02048
Hotel Reservations can be made by calling Holiday Inn Mansfield 508-339-2200. Use special code SER. Special Roundup price is $102.00
OR CLICK THE LINK BELOW TO SEND AN EMAIL REQUESTING A REGISTRATION FORM
