53rd Annual World Service Business Conference
Our Primary Purpose
April 28 – May 3, 2014
Region Chair Registration Form
Region Chair Registration Deadline: December 30, 2013
Region Office Information (please print)
Region
Region Office #
Street/PO Box Address
Region #
City
State/Province
Postal Code
Country
Telephone
Email Address
Opt out of hard copy of Final
Conference Report?
Yes
No
For Office Use Only – Do Not Write Within This Box!
Bylaws Revision Date
In Conflict?
Yes
No
If bylaws are in conflict, date service body notified.
Region Chair Qualifications
Each region chair must sign in the “Signature” field affirming his/her compliance with OA, Inc. Bylaws,
Subpart B, Article X, Section 3c) 1 below.
*Qualifications for selection of World Service delegates/alternates shall be set by each intergroup, region
(in the case of region delegates) or service board provided that each delegate/alternate shall have at least
one year of current abstinence and at least two years of service beyond the group level. (Permission for
any exception in qualifications for valid reasons, if deemed credible by the trustees, may be received by
application to the World Service Office.)
Important Region Chair Information!
Once region chairs are properly registered with the World Service Office, they will receive a separate questionnaire
via email (US mail if email address is not listed) requesting additional information such as Green Dot/Mentor
Program participation, roommate request, Final Conference Report options, committee preference, Saturday banquet
reservation, etc.
All regions are required to send in their latest set of bylaws or statement of
purpose with the region chair registration form.
Region Chair Registration Form 2014
Page 1
Region Chair Registration (please print)
Region Chair Name
Region Chair Signature* (required – see page 1 for
qualifications)
Street/PO Box Address
City
State/Province
Postal Code
Country
Telephone Number (
primary)
Cell/Mobile Number (
Email Address
primary)
Badge Name
Note: Badge will include “badge name,” city, state/province, country (if outside of the USA), region number, region
number and region name. If the “badge name” field is not completed above, the WSO will use the “region
chairman name” for the badge.
Payment Information
Payment is required in US funds. The fee is $99 USD for each registered region chair and includes the Saturday
banquet. A $20 USD non-refundable fee will apply for all cancellations. No refunds on or after April 1, 2014.
Please make checks payable to “Overeaters Anonymous.”
# of Region Chairs @ $99 each _________
Total Enclosed $__________
Type of Payment
Discover
MasterCard
Check/Money Order # ______
For Office Use Only
Do not write within this box!
Total Amount
Visa
Name on Card
Check/Money Order #
Card Number
CC Authorization #
Expiration Date
Security Code (3-digit code on back of card)
Billing Address
Signature
Return this form with the following:
 $99 USD registration fee for each region chair ($20 non-refundable fee on cancellations)
 Signature of region chair affirming qualifications
 Copy of current region bylaws or statement of purpose
Region Chair Registration Form 2014
Page 2
Region Appeals Committee Members
WSBC Policy 2004 (amended 2009)
2) Each region will provide, at the time they submit their delegate information, a list of up to
five individuals willing to serve on an Appeals Committee in the event of denial of delegate
credentials. The Appeals Review Committee shall be composed of two members of the Board
of Trustees, two region chairmen and two representatives of the region bringing the appeal.
Name
Street/PO Box Address
City
State/Province
Postal Code
Country
Telephone Number (
primary)
Cell/Mobile Number (
primary)
Email Address
Name
Street/PO Box Address
City
State/Province
Postal Code
Country
Telephone Number (
primary)
Cell/Mobile Number (
primary)
Email Address
Name
Street/PO Box Address
City
State/Province
Postal Code
Country
Telephone Number (
primary)
Cell/Mobile Number (
primary)
Email Address
Region Chair Registration Form 2014
Page 3
Region Appeals Committee Members
Name
Street/PO Box Address
City
State/Province
Postal Code
Country
Telephone Number (
primary)
Cell/Mobile Number (
primary)
Email Address
Name
Street/PO Box Address
City
State/Province
Postal Code
Country
Telephone Number (
primary)
Cell/Mobile Number (
primary)
Email Address
World Service Office – Sandy Hickox
PO Box 44020, Rio Rancho, NM 87174-4020 USA
T (505) 891-2664
F (505) 891-4320 Email: [email protected]
Region Chair Registration Form 2014
Page 4