2021 NCR Triennial Convention Delegate Registration Form

Purpose of Registration

Please indicate the reason you are completing this form. *

Option A - I am completing this registration form for a union body* in which NO DELEGATE has been registered.

Option B - I am completing this registration form for a union body* in which there has been CHANGES TO DELEGATE credentials.

*A union body is a local, a component, NCR committees and NCR area councils.

If Option B, please elaborate.

If you are completing this form for reasons in option B, please indicate which Delegate you are replacing. Your Credentials Approver below will be including a copy of the minutes of the last union body’s meeting that reflects those changes.

Replaced Delegate's Full Name

Replaced Delegate's Personal/Union Email Address

Replaced Delegate's Phone Number

Delegate Information

PSAC ID *

First Name *

Last Name *

Address *

City *

Province *

Province Other...

Postal Code *

Home Telephone *

Work Telephone *

Personal Cell Phone

Personal (non-work) email *

Due to workplace firewalls, personal emails are required.

Fax

Component *

Local *

Local Other...

Language of Preference

Certification | Credentials

Certification/Credentials *

Alternate's Full Name

Alternate's PSAC ID #

Alternate's Personal Email Address

Credentials Approver Information

Please complete all fields below with required information on the approver.

Approver's Governance Title *

Approver's Governance Title Other...

Approver's Full Name *

Approver's Personal/Union Email Address

Approver's Phone Number

Questionnaire

Orientation Confirmation

I will be attending the Orientation Session on the Rules of Order, Thursday May 13, 2021 from 9am to 10am.

Caucus Selection

Please confirm whether you are choosing to attend any of the caucuses below for which you are eligible:

Caucus Options

Indigenous Action Circle: Wednesday, May 3, 2021

Young Workers' Committee: Tuesday, May 4, 2021

Women's Committee: Wednesday May 5, 2021

Members with Disabilities Action Committee: Thursday, May 6, 2021

Pride Committee: Friday, May 7, 2021

Separate employers Caucus and vote (only for the members of the separate employers): Monday, May 10, 2021

Racially Visible Action Committee: Tuesday, May 11, 2021

I will attend my above noted selection(s) from the May 3 to 11 caucuses.

Accomodation for Persons with Disabilities

If you are a member with a disability and require accommodation in order to participate in this course, kindly complete the following. The PSAC strives to ensure that PSAC events are barrier-free for members with disabilities.

Are you a member with a disability and requiring accommodation?

Yes

If yes, what are the functional limitations arising from your disability? (You are not obliged to disclose your diagnosis; only your functional limitations):

If yes, please specify the accommodation measures you therefore require:

For example, do you require... ?

For example, do you require... ? Other...

For the purposes of voting, do you require your name be added to the Door Tiling Accommodation List?

Yes

Optional Self-Identification

The PSAC is committed to ensuring that our events are accessible to all members. 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.

Check all that apply.

Gay, Lesbian, Bisexual, Transgendered, Q2+ Worker

Indigenous Worker

Racially Visible Worker

Woman Worker

Worker with a Disability

Young Worker (Under 35)

PSAC National Equity Contact Lists

Do you wish to add your name and contact information to one or more of our respective PSAC Equity and Young Worker contact lists?

Yes

This information is kept confidential. It may be shared with different structures of the union in support of our human rights work only.

Leave this field blank

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2021 NCR Triennial Convention Delegate Registration Form

Registrations Are Now Closed

Public Service Alliance of Canada - NCR.

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2021 NCR Triennial Convention Delegate Registration Form

Registrations Are Now Closed

Public Service Alliance of Canada - NCR.

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