PSAC-NCR 2024 Council retreat

REGISTRATION FORM

First Name *

PSAC ID *

Telephone (home) *

Do you need accommodation for this meeting?

If yes, please fill out the accommodation form.

Last Name *

Email *

Credentials *

Do you need childcare ?

If yes, please fill out the accommodation form.

Do you need paper copiesfor this meeting?

Name *

Phone *

Email *

Event / meeting

Which event do you require the accomodation for?

Do you self-identify as a member with a disability? *

If yes, what are the functional limitations arising from your disability? (You do not need to disclose your diagnosis)

Do you need assistance if the room is evacuated? *

Do you need an ergonomic chair? *

Will you need onsite childcare?

If yes, please mention how many kids as well as their age range

Do you require documentation an alternative media? *

If other, please specify

Dietary requirements or any allergies *

If other, please specify

Other comments