Regional Council Delegate Registration Form – Jan 30 Please enable JavaScript in your browser to complete this form.Delegate InformationPSAC ID *Name *FirstLastAddress *City *Province *Postal Code *Personal (non-work) email *Telephone (H) *Telephone (W)Component *DCL | SLCD – Directly Chartered LocalDCL | SLCD – Directly Chartered LocalAGR | AGR – Agriculture UnionCEIU | SEIC – Canada Employment and Immigration UnionCIU | SDI – Customs and Immigration UnionGSU | SSG – Government Services UnionNEU | SEN – Nunavut Employees UnionUCTE | UCET – Union of Canadian Transportation EmployeesUHEW | STSE – Union of Health and Environment WorkersUNDE | UEDN – Union of National Defence EmployeesUNE | SEN – Union of National EmployeesUNW | STN – Union Northern WorkersUPCE | SEPC – Union of Postal Communications EmployeesUSJE | SEJG – Union of Safety and Justice EmployeesUTE | SEI – Union of Taxation EmployeesUVAE | SEAC – Union of Veterans Affairs EmployeesYEU | SEY – Yukon Employees UnionI don't knowLocal0063000646007801045270000700017000370004700057000670007700087000970010700117001270013700157001770018700197002070021700237002470027700287003070035700407004170044700557005970061700667006770075700807008170082700837008470088700937010170125701307013870139701487015170153701557016070165701727017470176701807A180701817018370263702917029270312703427036770369703727038070381703907039570396703977039970400704017040470405704077040870409704107050170602706037060570607706087061170612706147061770654706827068470701707027070370704707057070770708707097071070712707137071470742712007120171250712557200073100751007A0057B0057C0057D0057E0057F005I don't knowNot a member of PSACCertification | CredentialsCertification/credentials Local PresidentLocal Member Mandated to represent LocalPrideRacially Visible Action Cmtee (RVAC)Members with Disabilities Action Cmtee (MDAC)Ottawa Regional Women’s Cmtee (ORWC)Men’s Action and Support CmteeComité régional des femmes francophone (CRFF)Ottawa Area CouncilConseil régional d’action politique de l’Outaouais (CRAPO)Aboriginal Action CircleYoung Workers CommitteeCommunications CommitteeEducation CommitteeHealth and Safety CommitteeNCR Component Regional OfficerRepresentative for component without NCR regional officers (only one delegate)NCRC Executive MemberSeparate Employer RepresentativeAlternative REVP-NCRLocal president nameE-mail of Local PresidentPhone number of Local PresidentCommittee Chair's nameCommittee Chair e-mailAlternate participantIn the event that you are unable to attend at the last minute, you may identify an alternate representative to fill your seat.Alternate NameAlternate's emailAccommodation for Persons with DisabilitiesDo you self-identify as a member with a disabilityYesNoDo you require documentation in alternative media? Please specifyDo you requiresign languageoral interpretationreader (for persons who are visually impaired)real-time captioningOther…If not indicated above, please list of your special requirements so that we can properly accommodate your needsSubmit
