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Register for Region 9 Assembly and Convention

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Name *

First

Last

Email *

Phone Number

Are you a

Region 9 Board Officer (Including Trustee Liaison)
Region 9 Committee Chair or Service Coordinator
Service Body Representative
Visitor

Please select your role

Trustee Liasson - Emilia
Chair - Loudovika
Vice Chair -Natasha
Treasurer - Ricki
Secretary - Sharlotte

Please select your role

Active Outreach Committee Chair
Nuts and Bolts Committee Chair
STC Committee Chair
Bylaws Coordinator
Sponsorship Coordinator

Select your Service Body

Name of Service Body Chair *

First

Last

Email of Service Body Chair *

I plan to attend

In person
Online

GDPR Agreement *

I consent to having Region 9 store my data for the purpose of assisting with this application and all date will be used in line with the terms of the Region 9 Privacy Policy.

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