CLC Convention 2026 Application

Current Section A - Personal Information
Section B - Questionnaire
Section C - Local Endorsement
Section D - Workshop Choice
Section E - Submission
Complete

First Name

Last Name

Home Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Mailing Address (if different)

Primary Phone

Cell Phone

Personal Email

Do not use your employer's email

Employer

Work Site Name

Job Title

HEU Local (if known)

Employment Status

Full-Time

Part-Time

Casual

Region

North

Interior

Vancouver Coastal (includes PHSA)

Fraser

Vancouver Island

Do you self-identify with any of the following equity groups? (Check all that apply):

Indigenous

2SLGBTQIA+

Worker of Colour

Worker with disabilities

2-Spirit, Woman, or Non-Binary

Young Worker (35 years or younger)

Older Persons (55 years or older)

Prefer not to say

Other…

We are collecting this information to ensure we have diversity at our event. This information will be kept confidential.

Emergency Contact Name

Emergency Contact Phone

Please check if you have any medical condition(s) or if there is anything else that we should be aware of that could impact your ability to participate in this event.

If yes, briefly explain (In some cases, a physician's note may be required)

Do you have any accessibility requirements? If so, please specify:

Disclaimer: Personal information collected on this form, will be used to process this application and to update your contact information in HEU’s membership database.