2017 Training Institute Registration
PLEASE READ THE FOLLOWING INFORMATION CAREFULLY AND THOROUGHLY BEFORE COMPLETING THIS FORM.

The PIH Engage Training Institute is a 2-day annual conference bringing together leaders in PIH Engage and across global health. Participants learn community organizing skills, commit to the yearlong PIH Engage campaign, hear from PIH leadership, and practice the campaign tactics they'll need to advance the right to health movement.

DATE: August 12-13, 2017 (optional meet and greet on Friday evening, August 11)
LOCATION: TBD

COST: The cost to participate in this year's Training Institute is $50, which will help us offset the costs of the conference.

DEADLINES: Fill out the form below to register! The deadline for registration (including payment of the $50 conference fee) is JUNE 10, 2017.
IF YOU REQUIRE FINANCIAL ASSISTANCE, the deadline to apply for financial aid is MAY 20, 2017. You will be directed to the financial aid application as you complete this form.

HOUSING: PIH Engage does not provide housing for this weekend. Participants are expected to make their own arrangements. You can find tips on the PIH Engage website.
IF YOU ARE A MINOR (<18 years old in the U.S.), you are REQUIRED to bring a chaperon in order to secure housing. Hotels and hostels will not allow minors to book rooms without a legal adult chaperon. Please keep in mind that some hotels also have booking restrictions (or additional deposits) for persons under 21 years old.

ACCESSIBILITY: Our goal is to make Training Institute accessible to everyone. For questions about accessibility or to request accommodations please contact jmendoza@pih.org as soon as possible.

Questions? Email jmendoza@pih.org

First Name (as you would like it to appear on your name tag)
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Last Name (as you would like it to appear on your name tag)
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What are your pronouns (as you would like them to appear on your name tag)?
Email
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Phone Number
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Street Address
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City
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State/Region
Postal Code
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PIH Engage Team
PIH Engage 2017-2018 Leadership Role
You must be confirmed in this role by your Team Coordinator from this year. If you have not been confirmed in this role by your Team Coordinator, we cannot guarantee you a spot at this year's Training Institute (please note your registration fee is nonrefundable).
Can you attend the entire Training Institute?
We expect each and every participant to attend the FULL conference, because each day builds on previous sessions. If you cannot attend a certain day, you will be missing out on important information and training experience. Please reach out to us to discuss any extraordinary circumstances that require you to miss part of the conference.
Have you been to Training Institute Before? Check all that apply.
Required
Do you have any dietary restrictions?
You will receive breakfast and lunch on Saturday and Sunday of the Training Institute.
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I understand that all minors will be required to bring a chaperon in order to secure housing.
Chaperons are not required to attend any part of the Training Institute, though they are welcome to sit in on any sessions that interest them. If chaperons plan on attending the full conference, they are asked to complete this registration form separately.
Emergency Contact first name
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Emergency Contact last name
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Emergency Contact phone number
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Emergency Contact email address
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What skill are you most hoping to build at the 2017 Training Institute?
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