Access Summit 2025 March 12, 2025March 12, 2025 Please enable JavaScript in your browser to complete this form.Name *FirstLastChosen Name (if different from Employer record)PSAC IDComponent or DCL *Local Number (if known)Home email *Home phone *Cell phone *Street addressCityPostal Code What is the biggest issue within our union for members with a disability?What non-profit organization in your community do you currently or have you worked with previously in support of persons with disabilities in your community?What PSAC Training courses or events have you attended previously?What is your priority for the persons with disabilities community in your region? LOSS OF SALARY: Please identify if you will require loss of salary for travel on Thursday April 10th, 2025. In most cases a half day will be needed for travel. If you require Loss of Salary for Thursday, Friday, Saturday, and Sunday please indicate below. Please include the following in your response: Number of Hours Loss of Salary Required and Which days(s) do you require loss of salary *Do you wish to self-identify? Choose as many as applicable Indigenous PersonWomanRacialized Person2SLGBTQIAPerson with a DisabilityYoung Worker (35 and under)SPECIAL DIETARY REQUIREMENTS AND/OR ALLERGIES Do you have any dietary requirements or any allergies that we should be aware of ? *YesNoThe PSAC is committed to ensuring that the accessibility and dietary requirements of our members are respected. Please indicate your needs in the box below 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.If yes to special dietary requirements/allergies please specifyACCESSIBILITY REQUIREMENTS FORM - Do you have a disability or disabilities? *YesNo The PSAC is committed to accessibility and therefore we ask that you complete this form if necessary so that the PSAC can ensure your full participation at the conference. The form is confidential and the information provided will not be disclosed except where necessary to respond to your request for accommodation. If yes to the above question, what are the functional limitations and restrictions arising from your disability or disabilities? (you do not need to disclose your diagnosis)Please list options for accommodating your functional limitations and restrictions in order to allow you to fully participate in the event.Other comments: You may be required to provide relevant medical documentation that will assist us to respond to your request.Emergency Contact Information (to be used only in an emergency situation) *FirstLastEmergency Contact's relationship to member *Emergency Contact's phone number *Submit Spread the word
