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National Capital Region Council

Delegate registration form

General Meeting of the NCRC - September 15, 2007
Registration will open Saturday September 15, 2007 at 8:30, the meeting will commence at 9:00 and conclude at
17:00 on Saturday September 15.
J.K. Wyllie Boardroom, 233 Gilmour, Ottawa

Deadline for registration: September 7, 2007
(Please print)
Name:   Component:
Address:  
City, Prov.:  Local:
Postal Code: PSAC I.D.:
Telephone:(H)  Facsimile: 
Telephone:(W):  E-mail: 

CERTIFICATION/CREDENTIALS 
  Local President OR
  Local Member mandated to represent Local *Alternate Name:

 

*If Local Member other than Local President: 

I hereby certify that the above-named will represent our Local:

Per ________________________________, Local President
Representative of:

Aboriginal Action Circle (AAC)

Conseil régional d'action politique de l'Outaouais (CRAPO)

Ottawa Regional Women's Committee (Ottawa RWC)

Men's Action and Support Committee

Outaouais Regional Women's Committee (Outaouais RWC)

Ottawa Area Council (OAC)

Pride Committee

Racially Visible Action Committee (RVAC)

Members with Disabilities Action Committee (MDAC)

Alternate Name:
NCR Component Regional Officer OR
Components without NCR Component regional officers may send one delegate
NCRC Executive Member
RVP - Countries Outside Canada
Alternate REVP-NCR
REVP-NCR

RETURN TO REVP-NCR
15 Holland Avenue, Ottawa ON  K1Y 4T2
FAX:  (613) 761-7606