Virtual Region Assembly Registration

         VIRTUAL REGION ASSEMBLY

JANUARY 18-20, 2019

“FIRST THINGS FIRST”

           REGISTRATION FORM- copy and send it to the secretary 

Chair or designated trusted intergroup servant must complete

Intergroup Name:
Intergroup Number:
Total Number of Groups:
Total Number of Representatives Allowed:

Registration fee is $20/representative.  Once your reps are registered you will be invoiced.  Please let us know if your IG is unable to pay the registration for all you reps and we will grant scholarships.

#1 Name:
Region Rep       Alternate          Visitor
Email:
Phone:
First Assembly?   Yes                   No
Willing to Mentor New Rep?          Yes      No
Committee Choice:

#2 Name:
Region Rep           Alternate          Visitor
Email:
Phone:
First Assembly?    Yes           No
Willing to Mentor New Rep?   Yes            No
Committee Choice:

#3 Name:
Region Rep            Alternate           Visitor
Email:
Phone:
First Assembly?   Yes          No
Willing to Mentor New Rep?    Yes       No
Committee Choice:

#4 Name:
Region Rep             Alternate           Visitor
Email:
Phone:
First Assembly?   Yes             No
Willing to Mentor New Rep?    Yes           N

#5 Name:
Region Rep            Alternate           Visitor
Email:
Phone:
First Assembly?   Yes        No       
Willing to Mentor New Rep?  Yes No
Committee Choice:

#6  Name:
Region Rep            Alternate      Visitor
Email:
Phone:
First Assembly?   Yes        No
Willing to Mentor New Rep?          Yes    No
Committee Choice:

#7  Name:
Region Rep            Alternate      Visitor
Email:
Phone:
First Assembly?   Yes        No
Willing to Mentor New Rep?          Yes    No
Committee Choice:
 
#8  Name:
Region Rep            Alternate      Visitor
Email:
Phone:
First Assembly?   Yes        No
Willing to Mentor New Rep?          Yes    No
Committee Choice:

Total number paid representatives ____________
Total number scholarships requested __________
Total number attending_____________________

I certify that the representatives and alternates listed on this certificate were elected by our Intergroup to serve during the dates listed below and are eligible to vote as defined in the Virtual Region Bylaws and Policy & Procedures Manual.
Chair Signature : ___________________________

 

Committee Options and explanations :
NEWSLETTER, WORKSHOPS/OUT REACH/12th-Step-Within, FINANCE, SPEAKER/SPONSOR LIST, SUGGESTED OA LITERATURE REVISION, IGOR or BYLAWS

 

After this form is completed please return to: SECRETARY@OAVIRTUALREGION.ORG

 

 

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