Rally for Healthcare Request Form

1. Your full name *This question is required.

2. Your email *This question is required. This question requires a valid email address.

3. Which SEIU-West unit or facility is requesting the Rally? *This question is required.

4. What is your role at this unit or facility? *This question is required.

It is very important that your unit leaders be involved in this event. If you haven't spoken to them about having a rally, please do so as soon as possible.

5. What is your preferred date for a Rally?
(These events take some time to coordinate, so please provide at least 2 weeks' notice) *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

6. Rally start time
(enter as HH:MM followed by a space and then AM or PM; e.g. 2:30 PM, 11:30 AM)

7. Expected length of Rally? (no more than 1 hour for the duration of winter) *This question is required.

8. What is your warm-up plan? *This question is required.

9. What is the location of the Rally? Note that Rallies must not take place on Employer property.
Please be as specific as possible in this answer (e.g. sidewalk in front of 23 Springwater Way, Saskatoon) *This question is required.

10. Approximately how many people can we expect at this Rally?
(Remember, attendance at Rallies cannot be on work time!) *This question is required.

11. Who will be the Rally Lead?
The Rally Lead will have additional duties during the picket including, but not limited to, leading chants, and distributing signs. *This question is required.

12. Are you aware of any local media outlets (radio stations, newspapers, etc.) SEIU-West communications staff should invite to attend? If yes, please provide the name of the station/paper below and we'll do the rest! *This question is required.