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Kaiser Union Delegates Conference Travel Information
PERSONAL INFORMATION
Name
*
First Name
Middle Name
Last Name
Name as it should appear on badge
First Name then Last Name
Preferred Pronouns
*
Please Select
She/Her/Hers
He/Him/His
They/Them/Theirs
Prefer not to say
Other
Email
*
example@example.com
Mobile Phone Number
*
-
Area Code
Phone Number
Are you under 35 years of age?
*
Yes
No
Is this the first SEIU convention you are attending?
*
Yes
No
T-shirt size?
Hoodie size?
EMERGENCY CONTACT INFORMATION
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
-
Area Code
Phone Number
Emergency Contact Relationship
*
TRAVELER INFORMATION
This information willl be used to book your airline ticket. You will need to have valid ID (real ID or passport if you have one) in order to travel by airplane to Philadelphia, PA. The information provided below should match your ID.
Passenger Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Drivers License State and Number; or Passport Number and Country of Issuance:
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
List any medical conditions/needs:
LANGUAGE JUSTICE
We are dedicated to fostering a convention where every delegate feels welcomed and valued. We aim to build a more inclusive space for all by recognizing and respecting diverse language preferences. Please share your verbal and written language preferences to help us achieve this goal.
Which spoken or sign language do you prefer for communication? (listed in alphabetical order)
*
Albanian
American Sign Language
Bilingual: Equally fluent in English and another language
Cantonese
English
French Canadian
I am comfortable and proficient with multiple and/or sign languages
Korean
Mandarin Chinese
Polish
Russian
Slovakian
Spanish
Vietnamese
Other
Which written language do you prefer for communication? (listed in alphabetical order)
*
Albanian
American Sign Language
Bilingual: Equally fluent in English and another language
Cantonese
English
French Canadian
I am comfortable and proficient with multiple and/or sign languages
Korean
Mandarin Chinese
Polish
Russian
Slovakian
Spanish
Vietnamese
Other
The majority of the content and presentations at the convention will be in English and in large group settings. Would simultaneous interpretation into your native language help you better understand and more fully participate in the program?
*
Yes
No
I can participate fully without interpretation.
DIETARY NEEDS
Do you have any medically diagnosed food allergies? (Check all that apply)
*
Dairy
Eggs
Fish
Peanuts
Shellfish
Soy
Tree Nuts
Wheat (gluten)
Not applicable
Other
Do you have other dietary restrictions due to lifestyle, health, or religion? (Check all that apply)
*
Diabetic
Gluten Free
Halal
Kosher
Vegetarian
Vegan
Not applicable
Other
HOTEL PREFERENCES
In order to conserve resources and send as many delegates as possible members must be willing to share a hotel room. Room shares will be based on people identifying with the same pronouns. If you have room sharing preferences please identify them below. This will not guarantee that is who you will be sharing a room with.
Name of Roommate Preference #1
First Name
Last Name
Name of Roommate Preference #2
First Name
Last Name
Name of Roommate Preference #3
First Name
Last Name
Submit
Should be Empty: