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PSA CPSU NSW Mental Health Conference 2023
*
1.
Contact Information
(Required.)
First Name
Last Name
Address
Suburb
Post Code
Email Address
Phone/Mobile Number
*
2.
PSA Membership Number
(Required.)
3.
Do you identify as
A person with a disability
Aboriginal or Torres Strait Islander
4.
Do you have accessibility requirements or need to discuss an adjustment in order to attend?
Yes
No
*
5.
I am a
(Required.)
Health & Safety Representative
Health & Safety Committee member
Central Councillor
Women's Councillor
Pride Councillor
Aboriginal Councillor
Elected Delegate from a Workplace Group
PSA Member
*
6.
Work Details
Your work details are required so that the letter requesting your special leave is forwarded directly to your supervisor.
(Required.)
Employer / Agency / School
Your job title
Your job title
*
7.
Your Human Resources and/or Supervisor/Manager/Principal details.
(the release letter will be addressed for the attention of this person)
(Required.)
8.
Please tell us if you need to fly to attend the conference, as the PSA will book flights.
Please note there will be no overnight travel allowance paid to attend this conference.
9.
Do you have any dietary requirements?
Yes
No
Please Specify
10.
Any further comments
Current Progress,
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