Group Contact & Intergroup Rep Sign-Up Form

Group Name*

Any Notes

Name*

Position*[select* position \"IGR\" \"Alt IGR\"]

Sobriety Date*

Phone*

Email*

Address

City

ST[select contact-state \"OH\" \"KY\" \"IN\"]

Zip Code

Which committee(s) are you most interested in?

[checkbox committee-interest use_label_element \"12 Step\" \"Accessibilities\" \"Archivist\" \"Footsteps\" \"Grapevine\" \"Membership\" \"Nominating\" \"PI/CPC Public Information / Cooperation with the Professional Community\" \"TLC Treatment Literature Correctional /Bridge the Gap\" \"Special Events\" \"Event Traditions Workshop\" \"Event Spring Fling\" \"Event Gratitude Breakfast\" \"Event Thanksgiving Banquet \" \"Event Alcathon\"]