Innovation Lab Team Member Registration

Thank you for your interest in the ASPPH Public Health Innovation Lab! In order to complete your registration, please submit additional information about each team member by Monday, February 2, 2026 at 11:59 PM ET. Only one form should be submitted per team.

Innovation Lab – Participant Details

This form is for the collection of individual team details for the Innovation Lab. A link to this form should be included in the confirmation email in response to the submission of the Innovation Lab registration form.

"*" indicates required fields

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Team Member #1 (Team Captain)

Name*

First Last

Preferred Name*

Pronouns*

Email*

Phone*

Major*

Dietary allergies or restrictions*

Emergency Contact

Name*

Phone Number*

Team Member #2

First Name*

Last Name*

Preferred Name*

Pronouns*

Email Address*

Phone*

Major*

Dietary allergies or restrictions*

Emergency Contact

Name*

Phone Number*

Team Member #3

First Name*

Last Name*

Preferred Name*

Pronouns*

Email Address*

Phone*

Major*

Dietary allergies or restrictions*

Emergency Contact

Name*

Phone Number*

Team Commitment

We commit to attending the Virtual Orientation on Friday, February 27, 2026.*

Yes

If you answered No, please explain.*

Every team member is committed to attending every in-person session, Sunday March 15 – Friday, March 20, in Arlington, VA*

Yes

Unsure

If selected No or Unsure, please provide additional details.*

Teams with members unable to join every in-person session will be waitlisted.

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