Metro Memo Submissions – Overeaters Anonymous® for New York City

Text area 2 can go here:

* indicates required field

First Name:*

Last Name:*

Email:*

Re-enter Email:*

Contact Phone: (Please enter as follows: 212-555-1212)*

I am already registered for 2012 R6 Convention in Ottawa:*

Yes No

I attended the 2011 R6 Convention in White Plains:*

Yes No

What is your home zip code?*

(Your zip code enables us to better understand where people are and if we need to look at adding an additional bus)

I would like to do service and help out with the bus charter committee:*

Yes No Maybe

Please let us know if you have additional questions, also tell us additional information or how you would like to help.

CAPTCHA Code:*