Assembly Registration with credit card

ASSEMBLY REGISTRATION 
and payment with credit card



We require contact information so we can communicate with you about the assembly. We never share this information with anyone else. See our Privacy Policy for more information.

   Representative    Alternate Representative    Visitor




Thank you for offering information about your stay. This will help us better accomodate you as well as meet our contractual obligations. Please supply the following information:


 Yes    No

 Yes    No

 Yes    No
 Yes    No

 Yes    No






Please let us know in order of preference which committee you would like to participate in. For a description of each committee and its purpose visit our committee page.



 Bylaws
 Diversity
 Intergroup Outreach
 Public Information
 Twelve Step Within
 Young Persons
 Not Applicable- I'm a visitor

 Bylaws
 Diversity
 Intergroup Outreach
 Public Information
 Twelve Step Within
 Young Persons
 Not Applicable- I'm a visitor

 Bylaws
 Diversity
 Intergroup Outreach
 Public Information
 Twelve Step Within
 Young Persons
 Not Applicable- I'm a visitor



Please provide us with your intergroup contact information.


If you are a Representative or Alternate Representative, have you been duly selected by your Intergroup to serve at the Region 2 Assembly and will your Intergroup Chair and Secretary confirm this, if needed?

 Yes    Not Applicable - I am a visitor



Your billing address must match the address on your credit card statement or your credit card may be declined.

  Same as Mailing address



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