HLA Registration, April 19

Health Law Advocates Registration Form

Legal Education Program

Educating lawyers about the Social Determinants of Health (SDOH)

Friday, April 19, 2024

Venue: Virtual through Zoom

First Name

Last Name

Email

Phone

What is your current job/professional title?

If you answered "Other" above, please specify here.

Years in current position?

0-5

6-10

11-15

16+

If you answered "Other" above, please specify here.

Have you attended other trainings on law topics related to the social determinants of health (mental health, violence & abuse, poverty, aging, neighborhood safety, education, health behaviors, housing, job & income, access to clinical care, access to childcare, or infrastructure & transportation)? If so, please name the organization that hosted the training & the content covered.

Please let us know below if you have any dietary restrictions.

If you answered "Other" above, please specify here.

What is your gender identity?

If you answered "Other" above, please specify here.

How would you describe your racial identity? (Check all that apply)

How would you describe your ethnicity?

Hispanic or Latino

Not Hispanic or Latino

Will you be requesting CLE/CJE credits for this program?

Yes

No

Other

If yes, please specify the state/jurisdiction for which you would like CLE/CJE credits.