Enrolment Card Title Mr.Ms.Mrs.MissMx.Ind.Dr. Home Address City Province ABBCMBNBNLNSNTNUONPEQCSKYT Postal Code HOME E-mail HOME Tel. No. Cell No. Date of Birth 20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 01020304050607080910111213141516171819202122232425262728293031 Gender FemaleMaleNon-binary / genderqueerPrefer not to say Language Preference EnglishFrench Employment Date 202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 01020304050607080910111213141516171819202122232425262728293031 R/B/I -------ACRDAEPAEROASTBMCCBCONSTCSCSCDFSDTEMEEXECFPSHAAHHTHRBHSEIIOIRAPKITSMDMETRONANONPBSOAEOCREPSPRPPMSBSDT Building -------BouchervilleCalgaryChalk RiverCharlottetownEdmontonFrederictonHalifaxKelownaKetch HarbourLondonM-10M-12M-13M-14M-17M-19M-2M-20M-22M-23AM-24M-27M-3M-32M-35M-36M-4M-40M-50M-54M-55M-58M-59M-6M-60M-7M-9MarkhamMississaugaMonctonMontreal, BMCMontreal, DecellesMontreal, RoyalmountOakvillePentictonSaguenaySaskatoonSt. John'sSussexTorontoU-61U-62U-66U-66AU-70U-72U-87U-88U-89VancouverVictoriaWaterlooWinnipeg Room Group -------ADASCSOPPGTO OP Group - Sub Group -------BINBLDGELEAELECHPHVACLSAMECHMECLPLAPRPSFRACVHECOMOFOCONT Level Position -------ContinuingTerm I agree to become a member of the Research Council Employees' Association and wish that it represent me as my bargaining agent. Please check the box if you agree.