Courtesy Form

IN ORDER TO BE PROCESSED THIS FORM MUST BE COMPLETED IN FULL AND RECEIVED NOT MORE THAN 2 MONTHS AFTER THE DATE OF THE EVENT. PLEASE SEND THIS FORM TO THE UNIT OFFICE VIA FAX (705) 742 8599 or EMAIL (office@pvncoecta.ca).

Association Reps Name*
Location*
Name of Staff Member
Staff Members Email*
Enter Email Confirm Email
Position*
- OECTA
- CUPE
- Administration
Occasion*
- illness
- death
- birth
- marriage
- other
Date*
MM slash DD slash YYYY
Details*

(i.e. name of deceased, location of funeral, length of illness, special award, etc.)
Full mailing address

(and home phone number if there is to be a delivery)
Charitable donation

In the case of a death in the member’s family, would they like a donation to a specific charity? If so, which charity? Please provide home address of member (above).
CAPTCHA