for-alex-tamie Please enable JavaScript in your browser to complete this form.I am a PSAC B.C. member who self-identifies as Racialized. *YesA racialized person in Canada is non-white in colour or race, regardless of place of birth. For the PSAC, this does not include Indigenous members as Racialized because they are a recognized and separate equity group. Only members who self-identify as Racialized can attend this conference. For further clarification of Racialized groups, please see “Equity Group Identification” section below. Personal informationName *FirstLastEmail *Personal, not employer email pleasePSAC ID number *Work phoneHome phoneCell phoneHome address *Address Line 1Address Line 2CityState / Province / RegionPostal Code— Select country —AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryWorkplace informationComponent / DCL *choose …AGRCEIUCIUDCLGSUUCTEUHEWUNDEUNEUSJEUPCEUTEUVAELocal / Branch number *Worksite address *Address Line 1Address Line 2CityState / Province / RegionPostal Code— Select country —AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryParticipant ProfileImportant note: The responses to these questions will be used in the selection process for delegates to the conference. To ensure that the conference responds to the needs of our members, we invite you to complete the following questions. This is my first PSAC Conference *YesNoIf you have recently attended other PSAC Events (such as conferences, courses, etc.) please list which events and describe how this has impacted your union activism.(In 150 words or less)I am a leader or member of a PSAC Regional and/or Component Human Rights or Racialized Committee/Caucus? YesIf yes, please specify(In 150 words or less)I am active on Racialized workers' rights in my union or workplace and/or active in the community on Racialized community members' issues.YesIf yes, please describe(In 150 words or less)I am active on other equity-seeking workers' rights in my union or workplace and/or active in the community on other equity-seeking community members' issues.YesIf yes, please describe(In 150 words or less)If you are chosen as a delegate for this Conference, how would this experience help you advance Racialized leadership, resilience, and engagement in your workplace, Local/Branch, Region, Component, and/or in your community? *(In 150 words or less)Equity DesignationPSAC members who belong to the following groups are invited to provide their equity designation(s). 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.I am a racialized person *YesA racialized person in Canada is non-white in colour or race, regardless of place of birth.I am racially visible (copy) *Black; African-Canadian; Person of African-Descent, CaribbeanChineseFilipinoJapaneseKoreanSouth-Asian (including Indian from India; Bangladeshi; Pakistani; South-Asian from Guyana, Trinidad, East Africa; etc.)Southeast Asian (including Burmese; Cambodian; Laotian, Thai; Vietnamese; etc.)Non-White West Asian, North African or Arab (including Egyptian; Libyan; Lebanese; Iranian; etc.)Non-White Latin American (including indigenous persons from Central and South America, etc.)Persons of Mixed Origin (with one parent in one of the Racially Visible groups listed above)I am racially visible (other)other, if not captured above.I am an Indigenous personYesI am a person with a disabilityYesFor equity purposes, “person with disabilities” means persons who experience barriers arising from impairments of a physical, mental, sensory, psychiatric or learning nature.I am a member of the 2SLGBTQIA+ communityYesTwo-Spirited, Lesbian, Gay, Bisexual, Transgender Persons, Queer, Intersex, AsexualI self-identify as a womanYesI am 35 years of age and underYesWhat is your year of birth?PSAC Contact ListsPlease add my name and contact information to one or more of our respective PSAC Equity and other PSAC Regional Committee contact lists.Please add my name and contact information to the PSAC B.C. Regional Newsletter distribution list.PronounsPlease indicate your pronouns (she, he, they, zhe, etc) below. More information on pronouns and building trans-inclusive workspaces can be found here. Loss of salary and expensesThe following information will only be used if you are selected as a delegate to the conference. Please identify if you will require loss of salary to be covered. In most cases, a full day will be needed to arrive in time for the program on Friday. If you require Loss of Salary for Saturday or Sunday, please indicate below (for budget tracking purposes). If selected as a delegate, I will require loss of salary coverage for my attendance at the Conference. *YesNoClassification/Step or Hourly WageNumber of Hours Loss of Salary RequiredWhich day(s) do you require loss of salary?If selected as a delegate, I will require an advance for expenses (including loss of salary) associated with this Conference. *YesNoI will need approximately $:Accommodation for disabilitiesThe following information will only be used if you are selected as a delegate to the conference.The PSAC Accommodation Policy strives to ensure that PSAC Conferences are barrier-free for members with disabilities. Once selected as a participant, members will be asked to specify their accommodation needs in order to facilitate their participation at this Conference.I am a member with a disability and require accommodation.YesYou 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. What are the functional limitations arising from your disability?You are not obliged to disclose your diagnosis, only your functional limitations.I require that the PSAC arrange for a personal care attendant to assist me in order for me to fully participate at the Conference.I require documentation in alternative media.I require sound amplification.I require sign language interpretation.I require an oral interpretation.I require that the PSAC arrange for a Reader (for a person with a visually related disability) to assist me in order for me to fully participate at the Conference.I will be using animal assistance (i.e. guide dog) at the Conference.If you require specific accommodation for a disability in your hotel room, specify hereThe PSAC has reserved a block of rooms at the Hilton Vancouver Metrotown for delegates in travel status (those who reside more than 80 KM from the conference venue). This hotel is unionized and accessible. If you have dietary requirements or allergies that the PSAC should be aware of, specify them here:Family careThe objective of the PSAC Family Care Policy is to remove one of the barriers which prevents members from participating fully in Union activities and which provides for the reimbursement of family care expenses. A copy of the policy is available on the PSAC website at www.psacunion.ca/family-care-policy. On-site childcare is intended to remove a barrier to a delegate’s ability to participate at the Conference and is provided only for those who could not otherwise attend, had the service not been available. Requests must be received no later than Friday, September 5, 2025. If there are any requests by participants, on-site childcare will be provided at the Conference for the activities outlined in the agenda. I require on-site child careYesEnter the number of children, their names and ages here. We will follow-up for additional information.Mode of TransportationPlease indicate your preferred mode of travel. Delegates are expected to travel by the most direct, economical means in accordance with the PSAC Travel Policy. Mode of TransportationAirBusFerryPersonal Motor VehicleCarpool (If yes, please indicate with whom below)DetailsPlease provide any relevant details here.Emergency contactPlease indicate the name of an emergency contact, their telephone number, and their relationship to you. Should an emergency arise while you are participating at the Conference, we will contact them.NameEmergency contact phone numberEmergency contact's relationship to the Delegate (e.g. mother, child, spouse, friend, etc.)Last SectionIs there anything else you would like to add to your application?With this application, I agree that, if selected as a delegate, I will attend and participate in all sessions of the PSAC BC Regional Conference for Racialized Members, scheduled for Friday to Sunday, Octobr 3, 4, and 5, 2025. Submit