Region Rep 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 also recommended that you send a follow up email to to confirm your registration was received.


You can also click here to download a registration form and scan/email it to

Intergroups requiring funding assistance to attend Assembly may contact the Delegate Funding Coordinator at or the R4 Tresurer at 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

You must register at least one Representative, even if no one will be attending the upcoming assembly. Complete the form and scroll to the bottom and submit.   If you wish to register more than one Representative click here.

R4 Representative Registration Form
* indicates required field
Click here to locate your IG address
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.

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