2025 Racialized Member Conference 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 *NextI self-identify as a racialized member *YesNoIf you identified as a racialized member, we invite you to further self-identify Please select if applicableBlack; African-Canadian; African Nova-Scotian, Person of African-Descent; CaribbeanChineseFilipinoJapaneseKoreanSouth-Asian (including Indian from India; Bangladeshi; Pakistani; Guyana; Trinidad; East Africa; etc.)Southeast Asian (including Burmese; Cambodian; Laotian; Thai; Vietnamese; etc.)Non-White West Asian; North African or Arab (including Egyptian; Libyan; Lebanese; Iranian; etc.)Non-White Latin American (including indigenous persons from Central and South America; etc.)Persons of Mixed Origin (with one parent in one of the Racially Visible groups listed above)How long have you been a PSAC member? *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. your your a PreviousNextPreviousSubmit
