Have you moved house, changed worksite, classification or email address?
 

Then please let us know, by completing the following form with your new details and returning it to the PSA/CPSU as soon as possible.  This information is STRICTLY CONFIDENTIAL.
 

Member Name:  _________________________________________________________________

Member Number:  _______________________ (please refer to your Ambassador Card)

Postal Address:  _________________________________________________________________

Residential Address (if the same as your postal address please state 'as above'):

_______________________________________________________________________________

_______________________________________________________________________________

Home Phone Number:  ___________________________

Current Employer:  ______________________________________________________________

Worksite Address:  ______________________________________________________________

Work Phone Number:  _____________ Fax Number:  ________________

Email Address:  ___________________________________

Classification:  _____________________  Increment Level:  _________________

Hours worked:  Full Time  Part Time/Number of hours worked  _________  (please indicate)