2020 PSAC Ontario Racially Visible Members Conference, February 7-9, 2020



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To ensure that the Conference responds to the needs of our members, please complete all sections
First and Last Name
PSAC Membership #
A1A 2B3
Local #
(123) 456-7890
(123) 456-7890
Please provide contact name and telephone #
If you are not selected as a Delegate to the conference, do you want to be considered as an Observer?
By checking the box above, observers acknowledge that they are responsible for securing their own travel and for covering all costs associated with their participation in the Conference. Observers will also be responsible to arrange for any childcare or accommodation needs directly with the hotel.
What PSAC Conference have you attended?
What Component Conference have you attended?
I am a member of PSAC Regional/Component Human Rights or Women's or Pride or Aboriginal or Racially Visible or Persons with Disabilities Committee(s)
Have you recently attended a PSAC or Component educational course?
Please list PSAC/Component Education courses you have attended (both weekend and in-residence)
How will the knowledge and experience you gain at the conference lead to Union action in your workplace, your local, region, component or your community? (150 words or less)
Are you active in your community on Equity issues? Specify
Do you have any dietary requirements or any allergies that we should be aware of?
Tell us how you're getting here. Participants are expected to travel by the most direct, economical means and all travel must be pre-approved with the conference administrator prior to attending
Please identify if you will require loss of salary for travel on Thursday, February 8, 2020. In most cases, a half day will be needed for travel. If you require Loss of Salary for Friday, Saturday, and/or Sunday, please indicate below, (for budget tracking purposes) Classification/Step or Hourly Wage, Number of Hours of Salary Required, Which days do you require loss of salary
Do you require on-site childcare? *We will follow-up for additional information
The PSAC Accommodation Policy for delegates at PSAC Conferences strives to ensure that conferences are barrier-free for delegates with disabilities. Once selected, members may be required to specify further their accommodation needs in order to facilitate their participation at this conference. A separate form will be sent to select delegates
Our Organization: