Violence in the workplace training - Registration Form

REGISTRATION FORM

Please return the registration form by fax to 514-288-0494 or
1-800-288-0494 or by email to arenaud@pipsc.ca
NO LATER THAN SEPTEMBER 6, 2018

Last name:
First name:
Member no.: 
Address:
City:      
Province: Quebec
Postal code:
Tel.: (work):
Tel.: (home):
Email address:
Group:
Department/Agency:

Are you a member of an OSH Committee?
yes
no

If so, at what level?
local
regional
national

Need for accommodation (please check the days for which we need to book you a room):
Tuesday*
Wednesday
Thursday

*Mileage and travel time to the hotel (no reservation will be made for Wednesday if this section is not completed) 
    
KM:

TIME:

Special needs for meals, etc.:      

Will someone be accompanying you?
yes
no

(Please note that because PIPSC has not negotiated any arrangements for spouses, additional costs will be charged to individual accounts.)

Accommodation and meals will be provided onsite and your salary will be reimbursed for Wednesday, Thursday and Friday (and part of Tuesday if you need to take time off work to travel). You must request leave from your employer and obtain a leave form signed by your immediate supervisor.  Your transportation and other expenses will also be reimbursed, as provided in PIPSC’s Travel Policy. Travel and salary claims are available on the PIPSC site.

Training begins: Wednesday, October 17, 2018 at 8:30 a.m.
Departure from hotel: Friday, October 19, 2018 around 4:30 p.m.

N.B. Should you need to cancel, please notify us as quickly as possible or PIPSC may have to charge you for the cancellation costs.