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Regional Council
Regional Council Delegate Registration Form
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Regional Council Delegate Registration Form
Delegate Information
First Name
*
Last Name
*
Address
*
City
*
Province
*
Postal Code
*
Telephone (H)
*
Telephone (W)
*
Component
*
- Select -
DCL | SLCD - Directly Chartered Local
AGR | AGR - Agriculture Union
CEIU | SEIC - Canada Employment and Immigration Union
CIU | SDI - Customs and Immigration Union
GSU | SSG - Government Services Union
NEU | SEN - Nunavut Employees Union
NRU | SRN - National Resources Union
UCTE | UCET - Union of Canadian Transportation Employees
UHEW | STSE - Union of Health and Environment Workers
UNDE | UEDN - Union of National Defence Employees
UNE | SEN - Union of National Employees
UNW | STN - Union Northern Workers
UPCE | SEPC - Union of Postal Communications Employees
USJE | SESJ - Union of Safety and Justice Employees
UTE | SEI - Union of Taxation Employees
UVAE | SEAC - Union of Veterans Affairs Employees
YEU | SEY - Yukon Employees Union
I don't know
Local
*
- Select -
00630
00646
00780
10452
70000
70001
70004
70005
70006
70007
70008
70009
70010
70011
70012
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70059
70061
70066
70067
70075
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70081
70082
70083
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70088
70092
70093
70101
70125
70130
70138
70139
70148
70151
70153
70155
70160
70165
70172
70174
70176
70180
7A180
70181
70183
70263
70291
70292
70312
70342
70367
70369
70372
70380
70381
70390
70395
70396
70397
70399
70400
70401
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70407
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70608
70611
70612
70614
70617
70654
70682
70684
70701
70702
70703
70704
70705
70707
70708
70709
70710
70712
70713
70714
70742
71200
71201
71250
71255
72000
73100
75100
7A005
7B005
7C005
7D005
7E005
I don't know
NOT A MEMBER OF PSAC
PSAC ID
*
Fax
Personal (non-work) email
*
I need documents in paper form
*
Yes
No
I need access to wi-fi
*
Yes
No
Certification | Credentials
Certification/credentials
*
Local President
Local Member Mandated to represent Local
Pride
Racially Visible Action Cmtee (RVAC)
Members with Disabilities Action Cmtee (MDAC)
Ottawa Regional Women's Cmtee (ORWC)
Men's Action and Support Cmtee
Comité régional des femmes francophone (CRFF)
Ottawa Area Council
Conseil régional d'action politique de l'Outaouais (CRAPO)
Aboriginal Action Circle
Young Workers Committee
Communications Committee
Education Committee
Health and Safety Committee
NCR Component Regional Officer
Representative for component without NCR regional officers (only one delegate)
NCRC Executive Member
Separate Employer Representative
Alternative REVP-NCR
Local president name
E-mail of Local President
Phone number of Local President
Committee Chair's name
Committee Chair e-mail
Alternate participant
In the event that you are unable to attend at the last minute, you may identify an alternate representative to fill your seat.
Alternate Name
Alternate's email
Accomodation for Persons with Disabilities
Do you self-identify as a member with a disability?
Yes
No
Do you require documentation in alternative media? Please specify
Do you require
sign Language
oral interpretation
reader (for persons who are visually impaired)
real-time captioning
Other...
Do you require Other...
If not indicated above, please choose "Other" and list your special requirements so that we can properly accommodate your needs. If you require an ergonomic chair, please specify your limitations.
Do you have food allergies (please specify)
Leave this field blank
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