Multiple Representative Registration

Region requires that Representatives have at least six (6) months of current back-to-back abstinence. Our bylaws require that this form be on file sixty (60) days before the Region Assembly in order for your Region Rep to have a vote and to receive pertinent R4 information beforehand.

Intergroups are entitled to one Representative for every ten (10) groups and next fraction. It is suggested that you register the maximum number allowed.

See the form below to register online. It is recommended that you send a follow up email to apc@oaregion4.org to confirm your registration was received.  

If you need to print and manually complete your registration, click here to download the registration form.

Intergroups requiring funding assistance to attend Assembly may contact the Delegate Funding Coordinator at dfc@oaregion4.org or the R4 Tresurer at treasurer@oaregion4.org. Funding application forms are available here and are also in the Region 4 manual located here.

All Representatives are asked to choose one committee on which to serve from the following:

  • Convention
  • Outreach
  • Ways & Means/Finance

The form on this page allows you to register up to four representatives.   If you wish to register only one Representative click here.  If you wish to register more that four representatives, you will have to complete and submit the form twice.

Multiple R4 Representative Registration Form
* indicates required field
One rep for every ten (10) groups or portion there of.

All Representatives are asked to choose one committee on which to serve for until the following Assembly.



All Representatives are asked to choose one committee on which to serve for until the following Assembly.



All Representatives are asked to choose one committee on which to serve for until the following Assembly.



All Representatives are asked to choose one committee on which to serve for until the following Assembly.










I certify that the Representatives listed have at least six months current abstinence.