2025 2SLGBTQIA+ Summit Application Please enable JavaScript in your browser to complete this form. - Step 1 of 4Name *FirstLastPSAC ID (if unknown, enter 12345) *Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodePersonal Phone Number *Personal Email *EmailConfirm EmailLanguage *EnglishFrenchI am bilingualLocal number (if unknown, enter 12345) *Component *Please select your componentAgriculture UnionCanada Employment and ImmigrationCustoms and Immigration UnionDirectly Chartered LocalGovernment Services UnionUnion of Canadian Transportation EmployeesUnion of Health Environment WorkersUnion of National Defense EmployeesUnion of National EmployeesUnion of Postal Communications EmployeesUnion of Safety and Justice EmployeesUnion or Taxation EmployeesUnion of Veterans' Affairs EmployeesUnknownEmergency Contact *Emergency Contact Phone Number *Equity Group Self-Identification: PSAC members who belong to the following groups are invited to self-identify. WomanWorker with a disabilityIndigenous workerRacialized worker2SLGBTQIA+Equity Group Self-Identification: PSAC members who belong to the following groups are invited to self-identify. This information is kept confidential and will be used for the purposes of supporting our equity initiatives and programs. Please check all that apply. Please note that this information will be added to the Atlantic Region's equity email distribution list in support of our human rights work.NextI self-identify as a 2SLGBTQIA+ member *YesNoIf you identified as 2SLGBTQIA+, we invite you to further self-identify LesbianGayBisexualTransQueerTwo spiritedIntersexAsexualOtherEquity Group Self-Identification: PSAC members who belong to the following groups are invited to self-identify. This information is kept confidential and will be used for the purposes of supporting our equity initiatives and programs. Please check all that apply. Please note that this information will be added to the Atlantic Region's equity email distribution list in support of our human rights work.If you selected "Other", please specify below How long have you been a PSAC member? * a this restrictions What union positions do you hold?What other union or community experience do you have?Please briefly describe your interest in attending this conference and how you will make use of it? *PSAC strives to ensure that conferences 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 at the conference. 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): Breakfast and lunch will be provided at this conference. Please indicate if you have any dietary restrictions or allergies. *YesNoIf you selected yes, please specify to help us accommodatePreviousNextUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes.PreviousNextPreviousSubmit
