2020 NCR Triennial Convention Delegate Registration Form

Delegate Information

PSAC ID *

First Name *

Last Name *

Address *

City *

Province *

Province Other...

Postal Code *

Home Telephone *

Work Telephone *

Personal Cell Phone

Personal (non-work) email *

Due to workplace firewalls, personal emails are required.

Fax

Component *

Local *

Local Other...

Language of Preference

Certification | Credentials

Certification/Credentials *

Alternate's Full Name

Alternate's PSAC ID #

Alternate's Personal Email Address

Credentials Approver Information

Please complete all fields below with required information on the approver.

Approver's Governance Title *

Approver's Governance Title Other...

Approver's Full Name *

Approver's Personal/Union Email Address

Approver's Phone Number

Hotel Accommodation

The PSAC has reserved a block of rooms for Delegates at the Hilton Lac-Leamy, 3 Boulevard du Casino, Gatineau, QC J8Y 6X4. This hotel is unionized and accessible. Please note that the hotel is a smoke-free environment.

Will you require overnight accommodations during Convention? *

(For Delegate applications only.)

Questionnaire

Orientation Confirmation

I will be attending the Orientation Session on the Rules of Order, Friday April 17, 2020 from 8am to 9am.

Caucus Selection

Please confirm whether you are choosing to attend any of the caucuses below:

Friday April 17, 2020 Caucus Selection

Women's Committee

Young Workers' Committee

Indigenous Action Circle

I will attend my above noted selection for the Friday lunch caucus (Women's Committee, Young Workers' Committee or Indigenous Action Circle).

Saturday April 18, 2020 Caucus Selection

Members with Disabilities Action Committee

Racially Visible Action Committee

Pride Committee

I will attend my above-noted selection for the Saturday lunch caucus (MDAC , RVAC or Pride Committee).

Family Care

The objective of the PSAC Family Care Policy is to remove one of the barriers which prevents members from participating fully in Union activities and which provides for the reimbursement of family care expenses. A copy of the policy is available on the PSAC website at http://psacunion.ca/family-care-policy.

On-site child care is provided only for those delegates who could not otherwise attend, had the service not been available.

Please specify any questions or concerns here.

On-site requirement

If on-site child care is still required, please complete the information below.

Agreement Selection (FC)

I require on-site child care at the event.

Number of children:

Ages of children:

Accomodation for Persons with Disabilities

If you are a member with a disability and require accommodation in order to participate in this course, kindly complete the following. The PSAC strives to ensure that PSAC events are barrier-free for members with disabilities.

Are you a member with a disability and requiring accommodation?

Yes

If yes, what are the functional limitations arising from your disability? (You are not obliged to disclose your diagnosis; only your functional limitations):

If yes, please specify the accommodation measures you therefore require:

For example, do you require... ?

For example, do you require... ? Other...

Please advise us of any allergies (please specify)

You may be required to provide relevant medical documentation that will assist us to respond to your request. This information will not be disclosed except where necessary to respond to your request for accommodation.

For the purposes of voting, do you require your name be added to the Door Tiling Accommodation List?

Yes

Optional Self-Identification

The PSAC is committed to ensuring that our events are accessible to all members. PSAC members who belong to the following groups are invited to self-identify. This information is kept confidential and will be used for the purposes of supporting our equity initiatives and programs. Please check all that apply.

Check all that apply.

Gay, Lesbian, Bisexual, Transgendered, Q2+ Worker

Indigenous Worker

Racially Visible Worker

Woman Worker

Worker with a Disability

Young Worker (Under 35)

PSAC National Equity Contact Lists

Do you wish to add your name and contact information to one or more of our respective PSAC Equity and Young Worker contact lists?

Yes

This information is kept confidential. It may be shared with different structures of the union in support of our human rights work only.

Materials

Please note that all material will be provided in electronic format via the website only. Since there will be WiFi in the plenary, it is recommended to download the documents on to your device prior to the event. Paper copies are provided only to members with disability accommodations upon request. Without prior request, it will not be possible to provide on-site at the time of the event. The audited financial report and the resolutions report will be available in hard copy for everyone.

Text Agreement

I authorize PSAC to send me convention info via texts to my mobile for this event.

Leave this field blank

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2020 NCR Triennial Convention Delegate Registration Form

Public Service Alliance of Canada - NCR.

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2020 NCR Triennial Convention Delegate Registration Form

Public Service Alliance of Canada - NCR.

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