Name (required)

Workplace (required)

Address (required)

Postal Code (required)

Email (required)

Phone (required)

Name of workshop (required)

Location of workshop (required)

Date of workshop (required)

Reason for taking (required)

Position in Union (required)

Will you require accomodations? YesNo

If yes, for what dates: (required)

Who would you like to share a room with? (All requested accomodations will be arranged by the Local.) (required)

Who is your Area VP? (required)