October 22 to 25, 2015
Delta Sault Ste. Marie Waterfront
Sault Ste. Marie, Ontario
Registration Form
(Self-Funded Delegates and Observers from DCLs)
SECTION #1 - PERSONAL INFORMATION
NAME
LOCAL #
PSAC ID #
HOME ADDRESS
CITY, PROVINCE
POSTAL CODE
HOME TELEPHONE #
WORK TELEPHONE #
CELL #
PERSONAL EMAIL
UNION EMAIL
Paperless Conference
The Conference Organizing Committee has been mandated to deliver a “paperless conference” to the greatest extent possible. All delegates and/or observers are encouraged to participate in this endeavour by bringing a laptop. For those participating in the paperless conference, a USB key will be provided which includes all delegate conference materials. For those who would prefer to receive hard copies of delegate materials, please clearly indicate this preference on the registration form.
Delegate materials should be provided to me via (Please circle one):
USB Key / HARD COPYCLOTHING STYLE / CLOTHING SIZE
WOMENS / MENS / Small / Medium / Large
X Large / XX Large / XXX Large
SECTION #2 - Self-Identification (Optional)
PSAC members who belong to the following groups are invited to self-identify. This information is voluntary and kept confidential and will be used for the purposes of supporting our equity initiatives and programs. Please check all that apply.
Woman / Member With a Disability
Aboriginal Member / GLBTT1QQ2S*
Racially Visible Member / Young Worker (age 30 or under)
SECTION #3 - ROOM ACCOMMODATION
Accommodations are based on single occupancy with an option to share rooms in order to save costs and permit more members to attend. Please indicate if you are willing to share a room and the name of the person with whom you are willing to share in the space below.
SECTION #4 - TRAVEL ARRANGEMENTS
Please indicate your mode of travel.
The DCL opting to send a self-funded delegate and/or observer will be solely responsible for travel expenses. The Conference Organizing Committee would appreciate information regarding any self-funded delegate and/or observer’s travel plans in order to effectively manage this event.
Air
Rail
Bus
Personal Motor Vehicle
Will you be carpooling? Please indicate with whom.
SECTION #5 - ACCESS INFORMATION/DIET REQUIREMENTS
In the space below, indicate if you have any special requirements or accommodation needs. Please be as specific as possible to assist the facility in meeting your needs.
Special Diet: / Other (Please Specify):
Vegetarian / Vegan / Gluten Free
Allergies (Please Specify):
Special Needs (Please specify):
SECTION #6 - ENVIRONMENT
SMOKE FREE: All PSAC events, including this course, are smoke free. All rooms are non-smoking but there will be designated smoking areas outside.
SCENT FREE: To assist members with environmental sensitivities, all courses will be scent-free events.
STATEMENT ON HARASSMENT: All PSAC events are harassment free. We can neither condone nor tolerate behaviour which undermines the full and equal participation of all in union activities.
SPECIAL NEEDS - ACCESS AND DIET REQUIREMENTS: The PSAC is committed to ensuring that the accessibility and dietary requirements of our members are respected. Please indicate your needs in Section #5 above and provide any necessary explanation that will assist us in meeting them. PSAC will take the necessary action to ensure the availability of transportation, equipment and/or people required to enable all members to attend and fully participate in this Conference.
SECTION #7 – FAMILY CARE
To improve access to training for members with family care responsibilities, the PSAC has a National Family Care Policy. Family care will be provided in accordance with this Policy. If you require family care, please contact Kellie Loshak at:
SECTION #8 – COSTS FOR SELF-FUNDED DELEGATES AND OBSERVERS FROM DCLs
1. DCLs that receive 100% of the regional portion of their dues will be required to remit a $150.00 registration fee and self-fund their delegates and/or observers.
2. DCLs that opt to self-fund delegates and/or observers must purchase the standard group meal package as shown below.
3. Self-funded delegates and/or observers can opt for attending the Meet and Greet dinner and the discounted group rate for accommodations.
Please circle the Option 1 or Option 2 below and remit a cheque for the full amount with the completed registration fee:
CONFERENCE PACKAGES / OPTION 1 / OPTION 2
Registration Fee (Mandatory): / $150.00 / $150.00
Meal Package (Mandatory): / $144.12 / $144.12
Meet and Greet Dinner (Optional): / N/A / $26.00
Accommodation Package (Optional): / N/A / $482.56
Total Remittance / $294.12 / $802.68
SELF-FUNDED DELEGATE or OBSERVER FROM DCL SIGNATURE
SIGNATURE / DATE
PRESIDENT SIGNATURE
I approve the selection of this delegate / observer (please indicate) as one of the representatives of Directly-Chartered Local #______.
SIGNATURE OF PRESIDENT: / DATED:
Please remit this completed form along with the required payment to:
PSAC Kingston Regional Office
412-1471 John Counter Boulevard
Kingston, ON K7M 8S8
Attn: Kellie Loshak
Email:
Registration and payment must be received by: July 6, 2015