EHPS 2017: Synergy Expert Meeting application form
Please provide all the required information. Note that if your application is successful, this information will be included in the Participant Information Pack exactly as you enter it here.
Name
Your answer
Affiliation
Your answer
Country (in which you are employed)
Your answer
Email
Your answer
Job title
How would you describe your job title (e.g. PhD Student, Postdoc, Lecturer, Reader, Professor)?
Your answer
EHPS membership number
Note that SYNERGY participation requires EHPS membership and that all numbers are checked for their current membership status. If you are not yet a member, you can become an EHPS member, if your SYNERGY application was successful.
Your answer
Past experience
Please choose which of these applies:
Past experience (cont)
Please briefly describe your experience of applying theories and methods from Health Psychology in an Implementation Science context and/or your experience of implementing an evidence-based health psychology intervention in practice ' (word limit: 250). (Note that if your application is successful, this information will be included in the Participant Information Pack exactly as you enter it here.)
Your answer
Expectations
How do you expect the Expert Meeting to benefit you? (word limit: 250). (Note that if your application is successful, this information will be included in the Participant Information Pack exactly as you enter it here.)
Your answer
Contribution
What do you hope to contribute to the Expert Meeting? (word limit: 250) (Participants will be requested to prepare a 5 minute presentation to outline their experience in the area of Health Psychology Implementation Science) (Note that if your application is successful, this information will be included in the Participant Information Pack exactly as you enter it here.)
Your answer
Publications/presentations
If you have any publications/presentations that you think are relevant for this Expert Meeting, then please list the three most applicable here. Feel free to include any suggestions for publications or other documents that you think can be useful. The Expert Meeting facilitators will consider these as input for structuring the meeting, maybe sharing them with all delegates. (Note that if your application is successful, this information will be included in the Participant Information Pack exactly as you enter it here.)
Your answer
Dietary requirements
Please enter below any dietary requirements for the Synergy Expert Meeting dinner.
Your answer
Picture
Lastly, as part of the Participant Information Pack we want to provide individual pictures of all accepted delegates. Please send a recent picture of yourself to ehps.synergy@gmail.com. Please include your name and affiliation in the email.
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