PSAC 6th Triennial Atlantic Regional Convention
Saint John Trade & Convention Centre, Saint John NB
June 20-22, 2014

REGISTRATION/CREDENTIALS FORM

Please complete and return no later than April 11, 2014 if applying for a subsidy, or by May 20, 2014 without subsidy.

Personal Information:

I am registering as (check one):

I require a delegate subsidy:

SECTION 8

APPLICATION FOR DELEGATE STATUS

(A) Application for Local Delegate Status (Sub Section 1)

(B) Application for Area Council/NAPC Delegate Status (Sub Section 6)

(C) Application for National Officer Delegate Status (Sub Section 5)

I hereby certify that the above-named is a member in good standing and will represent as:
¨ National Officer
Signature: ______
(Component President / REVP)

(D) Application for Atlantic Council Delegate Status (Sub Section 7)

(E) Application for Delegate Status (Sub Section 3,4)

(F) Application for Regional Women’s Committee Delegate Status (Sub Section 2)

I hereby certify that the above-named is a member in good standing of the ______RWC and is applying to represent the RWC from the following province:
¨ NL ¨ NB ¨ NS ¨ PEI
Signature: ______
(Committee Chairperson)

(G) Application for Young Worker Delegate Status (Sub Section 8)

I hereby certify that the above-named is a member in good standing and is applying to represent Young Workers from the following province:
¨ NL ¨ NB ¨ NS ¨ PEI
Signature: ______
(Local President)

Please return the completed form by April 11, 2014 to receive delegate subsidy, or by May 20, 2014, by fax at 902-443-8291 or by mail to:

Convention Organizing Committee

PSAC Atlantic

Suite 301, 287 Lacewood Drive

Halifax, NS B3M 3Y7


CAUCUS REGISTRATION FORM

Name: ______

For purposes of caucus registration for voting, please indicate all that apply to you. This information is confidential and will only be shared after Convention with Council Directors and Regional Committees responsible for the various groups identified below should you check the release box below.

¨ Release ¨ Do not release

Province

¨ NL ¨ NB ¨ NS ¨ PEI

Non-Treasury Board Member

¨ Yes ¨ No

Directly Chartered Local Member

¨ Yes

Equity

¨ Aboriginal members

¨ Gay/Lesbian/Bisexual/Transgendered members

¨ Members with Disabilities

¨ Racially Visible members

¨ Woman

Other

¨ Francophone

¨ Young Worker

1 of 4