INTERGROUP REGISTRATION FORM

• Intergroup Name*
• Intergroup Phone number
• This field is hidden when viewing the form
  Alternate phone number
• Country*
  First ChoiceSecond ChoiceThird Choice
• State
  First ChoiceSecond ChoiceThird Choice
• City
• Intergroup Meeting and/or Mailing Address
  Information displayed in this field is shown in the public listing. Please do not include anyone's home address.
• Postal Code
• Email*
• This field is hidden when viewing the form
  Alternate Address
• Intergroup Meeting Details*
  Indicate when Intergroup meetings are held and include any access information, like zoom id, etc.
• This field is hidden when viewing the form
  Fax
• Website
• Region
  First ChoiceSecond ChoiceThird Choice

• PRIMARY CONTACT INFORMATION

  Please provide the full name and address of the Primary Intergroup Representative to the WSO. The information in this section will be for use only within the WSO service structure, will be kept confidential and will not be available on the public web site. Starred fields must be filled in. See note at top of form if you are unwilling to complete this section.

  Each Intergroup must have at least one contact person on record with his/her own mailing address.

• First Name*
• Last Name*
• Position in Intergroup*
• Street Address/PO Box*
• City*
• State/Province*
• Zip Code*
• Country*
• Phone
• Email*

• SECONDARY CONTACT INFORMATION

• First Name
• Last Name
• Position in Intergroup
• Street Address/PO Box
• City
• State/Province
• Zip Code
• Country
• Phone
• Email
• CAPTCHA