2021 PSAC BC ACTIVIST SUMMIT: Building Activism by Building Our Membership – application form October 14, 2000November 18, 2021 The deadline to apply has now passed and we will be in touch with all applicants shortly. Please enable JavaScript in your browser to complete this form.Name *FirstLastStreet Address *City *Postal Code *Home Phone *Cell PhoneWork PhonePreferred Email Address *Provide the address you would like used for all correspondence for the Summit – should not be an employer email.Alternate EmailPSAC ID Number *Component or DCL *Agriculture UnionCanada Employment & Immigration UnionCustoms & Immigration UnionDirectly Chartered LocalGovernment Services UnionUnion of Canadian Transportation EmployeesUnion of Health & Environment WorkersUnion of National Defence EmployeesUnion of National EmployeesUnion of Postal Communication EmployeesUnion of Safety & Justice EmployeesUnion of Taxation EmployeesUnion of Veterans Affairs EmployeesLocal or Branch Number *I authorize PSAC to send me Summit information via text (SMS) messages to my mobile phone for this event *YesNoParticipant ProfileImportant note: The responses to the questions below will be used in the selection process for delegates and observers to the Summit.How long have you been a PSAC member? *Indicate in years/months if possible.Please note any positions you hold on your Local/Branch ExecutiveIs this your first PSAC event? *YesNoIf this not your first PSAC event, what PSAC conferences or summits have you attended in the past?Please indicate the event(s) and what year(s) you attended.Have you attended any PSAC, Component, or JLP education courses in the past three years?Please indicate the course(s) and what year(s) you attended.Are you a member of a PSAC Regional Committee, Area Council or Component Committee?Please specify which one(s)What is your rationale for wanting to attend the 2021 PSAC B.C. Activist Summit? *In 150 words or less Please explain how attending the Summit will assist your activism in your workplace, community and/or the Union *In 150 words or less Voluntary Equity Group and Young Workers Self-IDPSAC 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 select all that applyI am a member of the LGBTQ2+ communityI am a person with a disabilityI am racially visibleI self-identify as a womanI am an Indigenous personI am a Young Worker (35 years of age and under)PSAC Equity Contact ListsPlease add my name and contact information to one or more of our respective PSAC Equity contact lists.This information may be shared with different structures of the union in support of our human rights work only. Advance / Leave With PayPlease select all that applyI will require an advance for expenses associated with the Summit.I will require a Leave with Pay Authorization Letter for my attendance at the Summit (applicable to PA, SV, TC, EB, FB, CFIA and Parks members)Emergency Contact InformationIn the unlikely event that we need to contact someone on your behalf, please provide the contact information for an emergency contact.Name *FirstLastRelationship to Participant *Phone *Going Green at our SummitClimate change, global warming and the protection of our environment are union issues. PSAC events and meetings all have an impact on our environment. We can help reduce this impact by adopting environmentally-friendly practices. PSAC has worked to create more sustainable union events to reduce our carbon footprint. Our actions have included reducing the amount of paper and materials distributed, and recycling and reusing materials. Together, we can make a difference. As part of these efforts, electronic copies of all Summit materials will be provided to participants. Will you require printed copies of the Summit materials in addition to the electronic copies? *YesNoAccommodation for DisabilitiesThe PSAC Accommodation Policy for delegates at PSAC events strives to ensure that events are barrier-free for delegates with disabilities. Once selected, members may be required to further specify their accommodation needs in order to facilitate their participation at these union activities. You may be required to provide relevant medical documentation that will assist us to respond to your request. This information will not be disclosed except where necessary to respond to your request for accommodation. I am a member with a disability and require accommodation.YesWhat are the functional limitations arising from your disability? You are not obliged to disclose your diagnosis, only your functional limitations.Please select all that applyI require a sign language interpretation.I require an oral interpretation.I require documentation in alternative media.I require real time captioning.Family Care for ParticipantsThe objective of the PSAC Family Care Policy is to remove one of the barriers which prevents delegates from participating fully in union activities and which provides for the reimbursement of family care expenses. A copy of the policy is available at www.psacunion.ca/family-care-policy Requests must be received no later than November 5, 2021. I require family care.YesPlease SpecifyWe will follow-up if we require additional information.Thank you for completing the application form!Submit Spread the word
