Atlantic Regional Council: Request for Information

Congratulations on your election to Atlantic Regional Council. To make the next three years as smooth as possible, please use the form below to provide some information about yourself and your needs.

Step 1 of 2

Personal information for purposes relating to expense claims, travel etc.

Name *

First

Last

(Preferred Name)

Pronouns

PSAC ID

Component/DCL

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Preferred Email for Communication until PSAC Email is Provided:

Preferred Language for Materials and Participation

French
English
Bilingual

limitations) are database

Shirt Size (Unisex)

Do you have a hard-wired headset with microphone for virtual meetings?

Indicate your nearest airport for commercial air travel:

Please indicate any dietary requirements and/or allergies that will assist us when making meeting arrangements:

Please indicate if you are a member with a disability and require accommodation:

If YES, what are the functional/cognitive limitations arising from your disability? Medical forms are required for adjustable chairs if not already in the PSAC database (You are not obliged to disclose your diagnosis, only your functional limitations)

Please list suggestions for accommodating your functional limitations:

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Atlantic Regional Council: Request for Information

Personal information for purposes relating to expense claims, travel etc.

Business Cards