1. Last and First Name:

2. Faculty and Department:

3. Mailing address to send information to me:
 
 
 
 

4. Phone number(s) to contact me:
Work:
Cell:
Home:

5. Email address:

The best way to contact me on short notice about an important matter needing my input on sessional rights is (check one):
6. Phone at work ___
7. Cell ___
8. Phone at home ___
9. E-mail ___

The following apply to me (please check as appropriate):
10. ___ Yes, I have submitted a signed membership card to the BUFA office.
11. ___ Yes, I would like to be involved with other sessionals to organize ways to improve sessional inclusion and rights at BU.
12. ___ Yes, I would be prepared to accept a nomination as sessional rep.