Request for Scholarship – 2025 Area 45 Convention

Southern New Jersey Area 45 ~ 59th Convention

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Scholarship Application Form

Please Note:

Scholarships cover the $40 Registration only. Meals are not included in the Scholarship.

Your Name*

First

Last

Name on Badge*

First

Last Initial

Your Email*

Email confirmation*

Phone Number*

Area Code

-

Phone Number

Sobriety Date*

Can you be of Service?

Yes, I can give one hour of service while at the Convention. I will check in at the Registration desk.

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