Register now! Please enable JavaScript in your browser to complete this form.Name *FirstLastPSAC ID (if unknown, 12345) *Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodePersonal email *Personal phone number *Preferred language of instruction and participation *EnglishFrenchEmergency Contact Name *FirstLastEmergency Contact phone number *Which regional committee or area council are you representing? *Which position do you hold on the committee executive? *PSAC strives to ensure that all training are barrier-free for members with disabilities. Once selected, members may be required to further specify their accommodation needs in order to facilitate their participation. A separate medical form will be sent to delegates who have identified as members with disabilities requiring accommodation. I am a member with a disability and require accommodation *YesNoWhat are the functional limitations arising from your disability? (You are not obliged to disclose your diagnosis at this time, only your functional limitations). Dietary requirements or allergies Breakfast and lunch will be provided. I have dietary requirements or allergies *YesNoPlease specify Do you require a union leave letter? *YesNoSelf-identification As part of our ongoing work to build an inclusive union for all members, we invite PSAC members to voluntarily self-idenfy as part of one or more equity-seeking groups. All information collected will be handled with strict confidentiality, and in accordance with PSAC’s privacy policies. Should you have any questions about how this information will be used and stored please reach out to equity-equite@psac-afpc.com.WomanWorker with a DisabilityIndigenous WorkerRacially Visible Worker2SLGBTQIA+ WorkerYoung Worker (35 or under)Francophone WorkerDISCLAIMER: Should you check the release box below, this information is confidential and will only be shared after the Conference with the Regional Council Director responsible. This information will help ensure that members stay connected to each other and the elected officials who represent them. *ReleaseDo not releaseI hereby certify that, to the best of my knowledge, the provided information is accurate. By selecting yes, this will act as a signature *YesSCENT-FREE REMINDER In consideration for the health of those who may suffer from environmental disabilities, and with the goal of eliminating a contaminant from the air, the PSAC requests that all participants attending any union function refrain from using scented products. These include scented perfumes, colognes, lotions, hairsprays, deodorants and other products promoted by the fragrance industry.Submit
