Membership Form
All fields are required.
Personal Information:
Name:
Work Address:
Phone Number:
Fax Number:
Email Address:
Employment Information:
Note: The following information is used for statistical purposes only and will be held strictly confidential
Ministry/Crown corporation:
Start Date with Government/Crown:
Current Job Title:
Current Employment Status:
Scope:
In-scope
Out-of-scope
If In-scope, which Union:
Status:
Permanent
Part Time
Term
Other
If Other, please indicate what type:
AGEN Membership Status:
Please Choose:
First Nation
Metis
Inuit
* Friends of AGEN
* Friends of AGEN are any non-Aboriginal people who support the vision/mission of AGEN
Are you interested in volunteering for Pikeskwewak, Speaker's Bureau
Yes
No
