Region Rep Assembly Registration Please enable JavaScript in your browser to complete this form.Name *Email *Subject *MessageIntergroup Name *WSO Number *Intergroup AddressInclude city, state/province, zip/postal codeIntergroup Phone Number *Number of Groups *One rep for every ten (10) groups or portion there of.Number of Representatives Allowed *Rep Name *Rep Address *Include city, state/province, zip/postal codeRep Phone Number *Rep Email *Rep Status *RepresentativeAlternateTerm Expires *First Assembly *YesNoWilling to Mentor a New Rep *YesNoAll representatives are asked to choose one committee on which to serve for until the following Assembly. Committee ChoiceConventionOutreachWays & Means/FinanceAcknowledgement *I certify that the Representatives listed have at least six months current abstinence.Intergroup Chair Name *Intergroup Chair Email *Submit