Registration Received

We have received your convention registration, {Name (First):45.3} {Name (Last):45.6}

Here is what you submitted:

Contact Information:

• Name: {Name (First):45.3} {Name (Last):45.6}
• Email: {Personal Email:2}
• Local number: {Local Number:39}
• Phone: {Phone:3}
• Address:
  {Address (Street Address):4.1}
  {Address (Address Line 2):4.2}
  {Address (City):4.3} {Address (State / Province):4.4} {Address (ZIP / Postal Code):4.5}

Emergency Contact:

• Name: {Name (First):54.3} {Name (Last):54.6}
• Relationship: {Relationship:55}
• Mobile: {Mobile Phone:56}

Participation:

• Region: {Region:40}
• Local Number: {Local Number:39}
• PSAC ID: {PSAC ID:63}
• Status: {Status:41}
• Language: {Language of preference:20}
• Convention documents in hard copy: {Convention documents:32}
• I require an advance: {Advance (Yes):57.1}

Accessibility:

• Ergonomic Chair: {Ergo Chair:43}
• Dietary Requirements: {Dietary:22}
• Accessible Hotel Room: {Hotel accommodations:50}
• Family Care Policy: {Will you be accessing the UVAE Family Care Policy?:23}

Travel:

• Mode of Travel: {Mode of travel:60}
• Frequent Flyer Numbers: {Frequent Flier Numbers:59:}

If you have questions or additions, please contact us.