Mini Day Retreat Registration Please enable JavaScript in your browser to complete this form.First Name *Last Name *Email *EmailConfirm EmailSign-up for our ASDI Ecares newsletter?Phone *AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeR3 Representative?YESNONew R3 Representative?YESNOIntergroup NameComment or MessageIf handicapped do you have other needs, what are they?Mini Day Retreat with Lunch *Price: $ 45.00Final Payments are due to Registrar by October 6, 2021 due to consideration of the lunch count for our caterer.Optional DonationOptional Donation to ASDI for Scholarship Fund Total$ 0.00MessageCONTINUE