SOPHIA’s HIA Practitioner Workshop Registration Form, 2016

March 6-7, 2016
Oakland, CA

The intended audience for the HIA Practitioner Workshop is current practitioners of Health Impact Assessment (HIA) who are interested in strategic HIA field-building. The 2016 Workshop welcomes participation from practitioners worldwide.

HIA practitioners interested in attending should:

1. Have direct experience in conducting HIA, or currently be involved in conducting their first HIA.
2. Be willing to join Working Groups (WGs) committed to conducting field-building activities at the workshop, and after the meeting via email and phone calls.

To register, please complete the following questions and submit this form. The Planning Committee (PC) will review all registration requests to verify the applicant’s direct HIA experience and commitment to field building. To promote robust conversation representing diverse perspectives of practice, the PC seeks to balance the attendee portfolio across geographies and organizations, and increase attendance from community-based organizations, community members, vulnerable populations, and practitioners from outside of North America.

Due to limited space, we can only accommodate 100 participants. We may not be able to accommodate registration requests for more than three individuals per organization. Please contact us if you are interested in registering more than three individuals from your organization.

Registration forms will be reviewed on a rolling basis. Within a few weeks, you will be contacted with instructions about how to proceed to confirm your attendance. Information lodging and travel will be provided at that time. Registration fee information can be found on the SOPHIA website (http://hiasociety.org/?page_id=833).

The deadline to register is Monday, February 1, 2016.
Name *
Title/Position *
Organization *
Organization Website *
Address (City, State/Province, Postal Code, Country) *
Email *
Phone *
1. Describe your experience conducting HIA. *
2. Please check off all the ways you have been involved in HIA:
3. Please list and briefly describe any HIA project(s) that you are currently working on:
4. Please indicate whether you have attended any of the following HIA related conferences:
5. Describe 1-2 specific things you are hoping to get out of attending this workshop. *
6. Are you currently leading a SOPHIA Working Group, or are you interested in leading one at the Workshop?
7. If you answered yes to Question 6, which Working Group or HIA topic area are you most interested in?
8. Are you interested in applying for a scholarship to cover registration and/or travel costs for the Workshop?
If yes, please indicate the US dollar amount of your request.
ATTENTION:
Please note that by completing this registration form, your registration to the HIA Practitioner Workshop is NOT complete. Once your registration form has been received, you will be contacted with further instructions about how to confIrm your registration to the workshop.
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