Atlantic Regional Council Request for information This form is essential to complete and will assist the REVP’s office with arranging travel, loss of salary, accommodation for a disability etc. for the Atlantic Regional Council meetings during this cycle. Please enable JavaScript in your browser to complete this form.Name *FirstLastWhat are you preferred pronouns?PSAC ID # *Component/DCL *Phone *Email *Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodePlease indicate the closest airport to your residence *Length of time to airport from your residence *Recent union positionsLanguage for material distribution *EnglishFrenchShirt size preference *SmallXLMediumXXLLargeXXXLOtherIf other please specifyPlease indicate your regular work hoursex: Monday-Friday 9 am to 5 pmI work irregular work hoursPlease indicate any dietary requirements and/or allergies that will assist us when making meeting facility arrangementsPlease indicate if you are a member with a disability and require accommodation *YesNoIf yes, what are the functional/cognitive limitations arising from your disability? i.e if you require an ergonomic chair, specify your requirement for requesting one. (You are not obliged to disclose your diagnosis; only your functional limitations)Please list suggestions for accommodating your functional limitations. Medical note may be required. Business cardsRegional Council business cards will be provided to those who complete this form, should you choose. Please fill out the information below of what you would like to appear on your bilingual business cards. The cost of the cards will be deducted from your director’s budget (approx. $150/each)NameFirstLastEmailAddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodePhoneSocial media tags Submit