Application Form: National Events Assistance Fund

Name

Local union number

Mailing address (# and street)

City

Province

Postal code

Telephone - home

Telephone - work

Fax

Email

Please complete the following as it applies to you:

I am a young worker (30 and under)

I am a racialized worker/person of colour

I am an Indigenous person – First Nations (North American Indian), Métis or Inuk (Inuit)

I am a person with a disability

I describe my gender as

I describe my sexual orientation as

What is your local union’s total membership?

What are the average monthly union dues paid by the members to your local?

Has your local ever participated in a national event?

Yes

No

Has your local ever attended national convention?

Yes

No

Based on current cost, what would be the cost to your local to send a member to the event?

Travel to/from the event

Hotel accomodations (Please specify number of nights and cost per night)

Lost wages

Per diem/meal allowance

Total cost

Would your local require an advance cheque to assist you?

Yes

No

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