Health Nexus (formerly OPC) is Ontario's leading bilingual health promotion organization.

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Building Capacity for Equity in Health Promotion

Learning Lab, Ottawa, November 29, 2010
8:30 a.m. - 4:00 p.m.
Richelieu Community Centre
300 Des Pères-Blancs Ave, Ottawa

Please complete the form below if you are interested in attending this learning lab.

Registration fee $35. There are a limited numbers of subsidies available. If you would like to receive a registration subsidy, please indicate this at the end of the form.

Spaces are limited, so register early.

Food and materials will be provided.

Note: All fields are required.

First Name
Last Name
Organization
Address
City
Province
Postal Code
Telephone
E-mail
Do you have any food restrictions?	Yes No
If yes, please specify:
Do you require wheelchair access?	Yes No
Which of the following do you work in?
	Public Health Community Health Centre Community organization Other (please specify)
Which best describes your role?
	Work with clients Management Policy and Planning Other (please specify)

How would you rate your knowledge and awareness of health equity?
	no knowledge and awareness minimal knowledge and awareness some knowledge and awareness great deal of knowledge and awareness
Of health equity as it concerns racialized communities?
	no knowledge and awareness minimal knowledge and awareness some knowledge and awareness great deal of knowledge and awareness
Which of the following areas of health promotion do you work in?
	Healthy eating / food security Physical activity Mental Health Promotion Other (please specify)
Briefly describe the work you do, how your work relates to health equity for racialized communities, and why you are interested in attending this workshop

If you require a registration subsidy, please indicate the reasons and the amount requested.

Would you like your name and email to be included in the participant list?
	Yes No
Registration fee $35 Method of payment *
	Credit Card (Pay on-line over a secure connection) Cheque Money Order Subsidy