2023 PSAC-NCR Convention – Delegates registration Form

The PSAC-NCR Regional Triennial Convention of the Public Service Alliance of Canada will be held at:

Ottawa Marriott
100 Kent St, Ottawa, ON K1P 5R7

Convention dates: June 16-18, 2023
Deadline for receipt of resolutions: May 29, 2023
Deadline for delegate registration: May 29, 2023

Please feel free to contact the REVP Office if you have any questions:

PSAC-NCR REVP Office
233 Gilmour, Suite 603
Ottawa, ON K2P 0P1

Tel: (343) 462-3450
Email: orizied@psac-afpc.com

Personal Information

PSAC Membership # *

I would like to register as a delegate

I would like to register as a delegate

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First name *

Last name *

What are your pronouns (eg: he/him, she/her, they/them?

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Mailing address *

Province *

Work phone

Mobile phone *

Alternate Email Address

(if different from above)

Local number *

City *

Postal code

Home Phone

Preferred email address *

(provide the address you would like used for correspondence for this conference – should not be an employer email)

Component or Directly Chartered Local *

Local name

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Approver's name *

Approver's phone *

Approver's email *

The president of the local or committee must certify that the person named above has indeed been chosen to represent them at the Convention

I authorize the PSAC to send me conference information via text (SMS) messages to my mobile phone for this event

I authorize the PSAC to send me conference information via text (SMS) messages to my mobile phone for this event

I will be attending the Orientation Session on the Rules of Order.

I will be attending the Orientation Session on the Rules of Order.

Emergency Contact

Name *

First

Last

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Relationship

Phone *

Voluntary Equity Group and Young Worker Self-Identification

PSAC members who belong to the following groups are invited to self-identify. This information is required should you wish to participate in caucuses and elections as an observer. This information is kept confidential and will be used for the purposes of supporting our equity initiatives and programs. Please check all that apply.

Woman
Worker with a Disability
Indigenous Worker
Racially Visible Worker (As defined by, Government of Canada, Treasury Board Secretariat, “Employee Self-Identification Form”)
2SLGBTQIA+ Worker
Young Worker (under the age of 35)

PSAC Equity Contact Lists

Please add my name and contact information to one or more of our respective PSAC Equity and Young Workers contact lists.

(This information is kept confidential.) Please note that this information may be shared with different structures of the union in support of our human rights work only.

Accommodation of a Disability

The PSAC strives to ensure that PSAC events are barrier-free for delegates with disabilities. Once selected, members may be required to further specify their accommodation needs in order to facilitate their participation at the Convention.

I am a member with a disability and require accommodation.

I am a member with a disability and require accommodation.

Checkboxes

I require that the PSAC arrange a personal care attendant to assist me in order for me to fully participate at the conference.
I require documentation in alternative media.
I require sound amplification.
I require a sign language interpreter.
I require an oral interpreter.
I require that the PSAC arrange for a Reader to assist me in order for me to fully participate at the Conference. (for a person with a visually related disability)
I will be using animal assistance (i.e. guide dog) at the Conference.

Hotel Accommodation

The PSAC has reserved a block of rooms. The hotel (s) is unionized and accessible. Please note that the hotel (s) is a 100% smoke-free environment.

I require specific accommodation for my disability in my hotel room.

I require specific accommodation for my disability in my hotel room.

Dietary Restrictions or Allergies

I have dietary requirements or allergies.

I have dietary requirements or allergies.

Participant Profile

Note: members of the nominations committee may not run for any elected positions or involved with any election campaigns during the PSAC NCR Regional Convention.

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Are you are first time delegate to a regional convention.

Are you are first time delegate to a regional convention.

Would you be interested in joining a Convention Committee?

Would you be interested in joining a Convention Committee?

Note: Members of the nominations committee may not run for any elected positions or involved with any election campaigns during the PSAC NCR Regional Convention.

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. We will follow-up for additional information and to confirm service.

I require on-site childcare.

I require on-site childcare.

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Number of children

Ages of children