Funding Application for Region 7 Assembly (for Intergroup use)

For use by Intergroups to apply for financial assistance to send its Region Representatives to the Region 7 Assembly, held in the fall and spring of each year. Intergroups must submit this application to Region 7 by the deadline which is 60 days prior to the Assembly. An email regarding acceptance will be sent no later than two weeks after the deadline.

Available Funding Benefits:
1. Region 7 will pay up to 1/2 the room charges (based on double occupancy). Receipts must be provided at time of reimbursement.
2. Region 7 will pay up to $35.00 per day for food for 3 days. Receipts must be provided at time of reimbursement.
3. Region 7 will reimburse travel expenses up to a maximum of two (2) vehicles (see Policy Manual Section 1, Article IV. E for details.)

Instructions: Complete and submit this form; fields with * are required. An Intergroup financial statement worksheet is included in this form for your convenience. Please upload an image or copy of your existing statements below if more convenient, or email them to the treasurer.
Reimbursement requests without receipts will not be honored. After Assembly, expenses will be reimbursed directly to the Intergroup, not the individual Representatives.

Your Name:*

Your Email:*

Intergroup Chair Email:*

Asssembly Dates:*

Please list the names of your Intergroup's Region Representatives below, one in each box. The number of allowable Representatives is limited by the number of meetings within your Intergroup (1 Representative per 10 meetings). Please contact a Region 7 Board member if you have questions.

Name(s) of Representative(s) Your Intergroup Will Send to Assembly:*

Please upload a copy of your financial statements, or fill out the financial statement in the next section.

FINANCIAL STATEMENT WORKSHEETPlease fill in the values below if you are not uploading your Intergroup's financial statement.

Cash on Hand from Most Recent Intergroup Treasurer's Report:*

Date of Last Intergroup Treasurer's Report:* (mm/dd/yyyy)

PLUS

Contributions:*

Fundraisers:

Assemblies:

Sales:

Other:

MINUS

Rent:*

Phone & Website (and other utilities):

Newsletter:

Travel:

Literature:

Other Expense:

Expected Cash on Hand After Most Recent Income and Expenses. (This value is calculated by the form, but should match your statement.)

MINUS

Prudent Reserve Amount:

Any Other Outstanding Financial Commitments?

Total Expected Available Cash on Hand:

Feel free to add comments or questions here:

Submit Funding Application

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