PSAC-NCR Convention late registration Please enable JavaScript in your browser to complete this form.Personal InformationPSAC Membership # *I would like to register as a delegateI would like to register as a delegateIf yes, please specify – CredentialsREVP-NCRComité régional des femmes francophone (CRFF)Communications Committee (CC)Conseil régional d'action politique de l'Outaouais (CRAPO)Directly Chartered Local Committee (DCLC)Education Committee (EC)Health and Safety Committee (HSC)Indigenous Action Circle (IAC)Local Member Mandated to represent LocalMembers with Disabilities Action Committee (MDAC)Ottawa Area Council (OAC)Ottawa Regional Women's Committee (ORWC)Pride Committee (PC)Racially Visible Action Committee (RVAC)Young Workers Committee (YWC)Separate Employer Representative (SER)Local Member Mandated to represent LocalMembers -at-LargeNCR Component Regional OfficerNCRC Executive MemberNational OfficerNIPCI don't knowPlease specify seat (i.e. which Local/area Council/Committee/etc. seat are you representing) :First name *Last name *What are your pronouns (eg: he/him, she/her, they/them?Mailing address *Province *ABBCMBNBNLNSNTNUONPEQCSKYTWork phoneMobile phone *Alternate Email Address(if different from above)Local number *City *Postal codeHome PhonePreferred 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 *AGRU – Agriculture UnionCEIU – Canada Employment and Immigration UnionCIU – Customs and Immigration UnionGSU – Government Services UnionUCTE – Union of Canadian Transportation EmployeesUHEW – Union of Health and Environment WorkersUNDE – Union of National Defence EmployeesUNE – Union of National EmployeesUNW – Union of Northern WorkersUPCE – Union of Postal Communications EmployeesUSJE – Union of Safety and Justice EmployeesUTE – Union of Taxation EmployeesUVAE – Union of Veterans' Affairs EmployeesYEU – Yukon Employees UnionDCL – Directly Chartered LocalsI don't knowLocal nameApprover'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 ConventionI authorize the PSAC to send me conference information via text (SMS) messages to my mobile phone for this eventI authorize the PSAC to send me conference information via text (SMS) messages to my mobile phone for this eventI will be attending the Orientation Session on the Rules of Order.I will be attending the Orientation Session on the Rules of Order.Emergency ContactName *FirstLastRelationshipPhone *Voluntary Equity Group and Young Worker Self-IdentificationPSAC 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.WomanWorker with a DisabilityIndigenous WorkerRacially Visible Worker (As defined by, Government of Canada, Treasury Board Secretariat, “Employee Self-Identification Form”)2SLGBTQIA+ WorkerYoung Worker (under the age of 35)PSAC Equity Contact ListsPlease 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 DisabilityThe 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.What are the functional limitations arising from your disability?(You are not obliged to disclose your diagnosis, only your functional limitations.)CheckboxesI 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 AccommodationThe 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.Please specifyYou 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.Dietary Restrictions or AllergiesI have dietary requirements or allergies.I have dietary requirements or allergies.Please specifyParticipant ProfileNote: members of the nominations committee may not run for any elected positions or involved with any election campaigns during the PSAC NCR Regional Convention. 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.Please select:Nominations CommitteeFamily CareThe 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.Number of childrenAges of childrenSubmit