PSSP MEMBERSHIP DATA UPDATE FORM
Please check your information over before you submit the data.

Basic Data

First Name:	Last Name:
Home Phone:	Work Phone:
Fax:	Email:
Work Location:

Home Address

Street & Number:

City:

Postal Code:

Your Profession

Attendance Counsellor	Child and Youth Worker
Court Liaison Worker
Educational Audiologist	Multilingual Education Consultant
Occupational Therapist	Physiotherapist
Psychoeducational Consultant	Psychological Associate
Psychologist	SALEP Worker
Social Worker	Speech-Language Pathologist
Student Equity Program Advisor

Job Status

Permanent	Temporary Contract
Full Time	Part Time

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