Form

A space for us to gather and connect (1)

Express your interest in attending one or more of the regional Hearth Summits

Through this form, The Wellbeing Project will collect your information, and share it with the local organising team(s), informing them of your interest in attending. Please note The Wellbeing Project, in the spirit of empowering each local organizing team, will not try to influence the decision that they might take regarding whether to extend you an invitation (preference will be given to those based in the local region for each regional Hearth Summit).

* Please note that invitations to Hearth Summit Higher Ed will mainly be reserved for representatives of higher educations institutions.

First name*

Last name*

Email*

Date of birth*

Day/Month/Year

In which country are you based?*

City*

Nationality*

Which ethnicity do you identify with?*

Which organisation / company / institution are you part of?*

If you do not currently work for an organisation or company, please write N/A

In which type of organisation do you work*

Which of the following best describes the area of focus for you or your organisation?*

Which of the following best describes the entity type of you or your organisation? *

With which of the following action areas are you or your organisation most engaged?*

Personal/professional profile, handle or website?*

e.g. LinkedIn, blog, Twitter, Instagram, Facebook etc.

How are you engaged in the social change sector?*

How would you describe your knowledge and experience of wellbeing?*

We aim to include a wide spectrum of wellbeing expertise within our community of attendees, ranging from newcomers to seasoned professionals.

How did you learn about the regional Hearth Summits? Do you have an existing relationship with The Wellbeing Project? If so, what is that relationship?*

Please tell us more about your motivation for attending a regional Hearth Summit*