Preferred Pronouns *

She/Her

He/Him

They/Them

Other

Membership Affiliation (select all that apply) *

SA (Sexaholics Anonymous)

SAA (Sex Addicts Anonymous)

SCA (Sexual Compulsives Anonymous)

SIA (Survivors of Incest Anonymous)

SLAA (Sex & Love Addicts Anonymous)

CoSA (Codependents of Sex Addicts)

S-Anon

Supportive Partner of an S-Member

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Ride Share *

Attendees of our retreat who don't have cars rely on other fellows for transportation to and from the retreat. If you have the ability to provide a ride to a fellow, your service is very much appreciated.

I can offer a ride

I need a ride

I'm not available to carpool

Service Position Availability (select all that apply) *

Helping prior to the retreat

On location set-up Friday

On location clean-up Monday

On location tbd help during the retreat

No, I am not available to provide service

Do you want to perform in Creative Expressions? *

Creative Expressions is an event where people showcase their talents and creativity. Spots are limited, and time per performance is capped at 5 minutes. If you would like to participate, please let us know here.

Yes

No

Undecided (this option does not secure your spot)

Will you be bringing a dish to the Potluck on Friday night? *

Yes

No, I will be contributing $20 towards catering instead

I will not be in attendance on Friday night

Do you need a scholarship? *

50% scholarships are given on a first-come first-served basis, and scholarship funds come exclusively from 7th Tradition donations from meetings and individuals. Requesting a scholarship does not ensure that a scholarship will be given. In order to secure your spot in "line", payment of 50% of your plan option is required. Please email chicago.s.retreat@gmail.com with any questions.

Yes

No