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Registration Form

Please complete this application form and return it to your PSAC Regional Office by the course registration deadline date.

Date of course (1):
Name of course (1):
Date of course (2):
Name of course (2):
Date of course (3):
Name of course (3):
Regional Office:	Select Toronto Sudbury Thunder Bay London Kingston
Your Name:
Component or Directly Chartered Local:
Choose your component Not sure Direct Charter Local (Please Indicate in Box Below) Agriculture Union Canada Employment and Immigration Union Customs and Immigration Union Environment Component Government Services Union National Component National Health and Welfare Union Union of Canadian Transportation Employees Natural Resources Union Nunavut Employees Union Union of National Defence Employees Union of Northern Workers Union of Postal Communications Employees Union of Solicitor General Employees Union of Taxation Employees Union of Veterans' Affairs Employees Yukon Employees Union
Local Union Position Title:
Address (Home address, city, province, postal code):
Work Telephone Number:
Home Telephone Number:
Personal E-mail:
Work E-mail:
PSAC Membership number:
Date of Completion of Talking Union Basics (TUB) Course (If Applicable):
Access or Special Needs/Accommodation (Please be specific or contact the PSAC.)
Would you like to be included on our contact list:	Yes No

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