SDOH & Place Symposium Application
The following form is used to either register or apply for a spot at the SDOH & Place Symposium, depending on your role in the SDOH & Place project. The Symposium will take place in-person on Friday, June 14th (2 - 7 p.m.) and Saturday, June 15th (9 a.m. - 3 p.m.) in downtown Chicago. Sessions will be live streamed and recorded for future sharing.

Deadline to submit this application by the end of May or until all spots are filled. All applicants will be notified of their application decision on a rolling basis. 

Food will be provided at the conference at no additional cost, however lodging and travel to Chicago will be the applicant's responsibility for non-Fellows. 
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Email *
Please select your role or team group: *
What is your name?  *
What is your current title? *
What is your current organization or affiliation? *
What are your preferred pronouns?
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Do you require any accommodations or preferences for the Symposium? (Captioning or Translation Services, etc.) If none, indicate "none." *
As part of the Symposium, all guests will be provided food at no extra cost. Do you have any food allergies we should be aware of?  If none, indicate "none." *
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