Women in Leadership 2026

Current SECTION A - Personal Information
Complete

Last Name

First Name

Address

City/Town

Province

Postal Code

Preferred Phone Number

Type of preferred phone number:

Secondary Phone Number

Type of secondary phone number:

Personal 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 any that apply)

Indigenous

2SLGBTQIA+

Worker with disabilities

Worker of Colour

2-Spirit, Woman, or Non-Binary

Young Worker (35 years or younger)

Older Persons (55 years or over)

Prefer not to say

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

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

Yes

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

Do you have any accessibility requirements (i.e. ergonomic chair)?

Yes

If so, please specify:

Why do you want to attend this workshop?

Signature

Please draw your signature above.

After the closing date of this workshop, you will be notified by email if your application is accepted, and you will be required to apply for a leave of absence for union business. Due to a limited amount of space, we may not be able to accept all applications. We will also notify unsuccessful applicants by email.

Please ensure the email address on your application is current.