Registration for the PSAC-NCR Council meeting- Fall 2024

DELEGATES

PSAC ID *

First Name *

Credentials *

Email *

Address

Province

Approvers name *

Alternate email

Last Name *

Local *

Component *

Telephone (home) *

City

Postal Code

Approvers email *

Alternate name

PSAC ID *

First Name *

Email *

Component *

Name of Local President *

Last Name *

Local *

Credentials *

Telephone *

Email of Local President *

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

Events