<!-- Begin Mailchimp Signup Form --><!-- [et_pb_line_break_holder] --><link href="//cdn-images.mailchimp.com/embedcode/classic-10_7.css" rel="stylesheet" type="text/css"><!-- [et_pb_line_break_holder] --><style type="text/css"><!-- [et_pb_line_break_holder] --> #mc_embed_signup{background:#fff; clear:left; font:14px Helvetica,Arial,sans-serif; }<!-- [et_pb_line_break_holder] --> /* Add your own Mailchimp form style overrides in your site stylesheet or in this style block.<!-- [et_pb_line_break_holder] --> We recommend moving this block and the preceding CSS link to the HEAD of your HTML file. */<!-- [et_pb_line_break_holder] --></style><!-- [et_pb_line_break_holder] --><div id="mc_embed_signup"><!-- [et_pb_line_break_holder] --><form action="https://chfg.us1.list-manage.com/subscribe/post?u=ead830413870aedf048abbe70&id=de67d13ec4" method="post" id="mc-embedded-subscribe-form" name="mc-embedded-subscribe-form" class="validate" target="_blank" novalidate><!-- [et_pb_line_break_holder] --> <div id="mc_embed_signup_scroll"><!-- [et_pb_line_break_holder] --> <h2>Subscribe to our mailing list</h2><!-- [et_pb_line_break_holder] --><div class="indicates-required"><span class="asterisk">*</span> indicates required</div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --> <label for="mce-EMAIL">Email Address <span class="asterisk">*</span><!-- [et_pb_line_break_holder] --></label><!-- [et_pb_line_break_holder] --> <input type="email" value="" name="EMAIL" class="required email" id="mce-EMAIL"><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --> <label for="mce-FNAME">First Name <span class="asterisk">*</span><!-- [et_pb_line_break_holder] --></label><!-- [et_pb_line_break_holder] --> <input type="text" value="" name="FNAME" class="required" id="mce-FNAME"><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --> <label for="mce-LNAME">Last Name <span class="asterisk">*</span><!-- [et_pb_line_break_holder] --></label><!-- [et_pb_line_break_holder] --> <input type="text" value="" name="LNAME" class="required" id="mce-LNAME"><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --> <label for="mce-WORK">Where do you work? <span class="asterisk">*</span><!-- [et_pb_line_break_holder] --></label><!-- [et_pb_line_break_holder] --> <select name="WORK" class="required" id="mce-WORK"><!-- [et_pb_line_break_holder] --> <option value=""></option><!-- [et_pb_line_break_holder] --> <option value="Primary Care">Primary Care</option><!-- [et_pb_line_break_holder] --><option value="Secondary care">Secondary care</option><!-- [et_pb_line_break_holder] --><option value="Tertiary care">Tertiary care</option><!-- [et_pb_line_break_holder] --><option value="Social Care">Social Care</option><!-- [et_pb_line_break_holder] --><option value="Mental Health Services">Mental Health Services</option><!-- [et_pb_line_break_holder] --><option value="Community Care">Community Care</option><!-- [et_pb_line_break_holder] --><option value="Educational institution/training">Educational institution/training</option><!-- [et_pb_line_break_holder] --><option value="Product or equipment design">Product or equipment design</option><!-- [et_pb_line_break_holder] --><option value="Commercial supplier">Commercial supplier</option><!-- [et_pb_line_break_holder] --><option value="Private healthcare">Private healthcare</option><!-- [et_pb_line_break_holder] --><option value="Other - healthcare">Other - healthcare</option><!-- [et_pb_line_break_holder] --><option value="Other - non-healthcare">Other - non-healthcare</option><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --> <label for="mce-MMERGE8">The name of your organisation </label><!-- [et_pb_line_break_holder] --> <input type="text" value="" name="MMERGE8" class="" id="mce-MMERGE8"><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --> <label for="mce-ROLE">Your role <span class="asterisk">*</span><!-- [et_pb_line_break_holder] --></label><!-- [et_pb_line_break_holder] --> <select name="ROLE" class="required" id="mce-ROLE"><!-- [et_pb_line_break_holder] --> <option value=""></option><!-- [et_pb_line_break_holder] --> <option value="Doctor">Doctor</option><!-- [et_pb_line_break_holder] --><option value="Nurse">Nurse</option><!-- [et_pb_line_break_holder] --><option value="Allied Health Professional">Allied Health Professional</option><!-- [et_pb_line_break_holder] --><option value="Pharmacist">Pharmacist</option><!-- [et_pb_line_break_holder] --><option value="Dentist">Dentist</option><!-- [et_pb_line_break_holder] --><option value="Manager">Manager</option><!-- [et_pb_line_break_holder] --><option value="Lecturer/Researcher">Lecturer/Researcher</option><!-- [et_pb_line_break_holder] --><option value="Designer">Designer</option><!-- [et_pb_line_break_holder] --><option value="Psychologist">Psychologist</option><!-- [et_pb_line_break_holder] --><option value="Student">Student</option><!-- [et_pb_line_break_holder] --><option value="Other Healthcare Role">Other Healthcare Role</option><!-- [et_pb_line_break_holder] --><option value="Other Non-healthcare Role">Other Non-healthcare Role</option><!-- [et_pb_line_break_holder] --><option value="Ergonomist/Human Factors">Ergonomist/Human Factors</option><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --> <label for="mce-MMERGE18">Your location <span class="asterisk">*</span><!-- [et_pb_line_break_holder] --></label><!-- [et_pb_line_break_holder] --> <select name="MMERGE18" class="required" id="mce-MMERGE18"><!-- [et_pb_line_break_holder] --> <option value=""></option><!-- [et_pb_line_break_holder] --> <option value="England">England</option><!-- [et_pb_line_break_holder] --><option value="Wales">Wales</option><!-- [et_pb_line_break_holder] --><option value="Scotland">Scotland</option><!-- [et_pb_line_break_holder] --><option value="Northern Ireland">Northern Ireland</option><!-- [et_pb_line_break_holder] --><option value="Outside the United Kingdom">Outside the United Kingdom</option><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --> <label for="mce-MMERGE7">Your job title </label><!-- [et_pb_line_break_holder] --> <input type="text" value="" name="MMERGE7" class="" id="mce-MMERGE7"><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --> <label for="mce-MMERGE11">City </label><!-- [et_pb_line_break_holder] --> <input type="text" value="" name="MMERGE11" class="" id="mce-MMERGE11"><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --> <label for="mce-MMERGE12">Contact number </label><!-- [et_pb_line_break_holder] --> <input type="text" value="" name="MMERGE12" class="" id="mce-MMERGE12"><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group"><!-- [et_pb_line_break_holder] --> <label for="mce-MMERGE19">Any comments? </label><!-- [et_pb_line_break_holder] --> <input type="text" value="" name="MMERGE19" class="" id="mce-MMERGE19"><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group input-group"><!-- [et_pb_line_break_holder] --> <strong>Get involved with the CHFG </strong><!-- [et_pb_line_break_holder] --> <ul><li><input type="checkbox" value="16" name="group[6825][16]" id="mce-group[6825]-6825-0"><label for="mce-group[6825]-6825-0">Promoting human factors where I work</label></li><!-- [et_pb_line_break_holder] --><li><input type="checkbox" value="32" name="group[6825][32]" id="mce-group[6825]-6825-1"><label for="mce-group[6825]-6825-1">Providing a venue for a seminar</label></li><!-- [et_pb_line_break_holder] --><li><input type="checkbox" value="64" name="group[6825][64]" id="mce-group[6825]-6825-2"><label for="mce-group[6825]-6825-2">Helping to arrange a seminar</label></li><!-- [et_pb_line_break_holder] --><li><input type="checkbox" value="128" name="group[6825][128]" id="mce-group[6825]-6825-3"><label for="mce-group[6825]-6825-3">Speaking at conferences</label></li><!-- [et_pb_line_break_holder] --><li><input type="checkbox" value="256" name="group[6825][256]" id="mce-group[6825]-6825-4"><label for="mce-group[6825]-6825-4">Donating money</label></li><!-- [et_pb_line_break_holder] --><li><input type="checkbox" value="512" name="group[6825][512]" id="mce-group[6825]-6825-5"><label for="mce-group[6825]-6825-5">Sponsoring an event</label></li><!-- [et_pb_line_break_holder] --><li><input type="checkbox" value="8192" name="group[6825][8192]" id="mce-group[6825]-6825-6"><label for="mce-group[6825]-6825-6">I've got a story to tell and share</label></li><!-- [et_pb_line_break_holder] --></ul><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><div class="mc-field-group input-group"><!-- [et_pb_line_break_holder] --> <strong>I would like to learn more about: </strong><!-- [et_pb_line_break_holder] --> <ul><li><input type="checkbox" value="1024" name="group[6829][1024]" id="mce-group[6829]-6829-0"><label for="mce-group[6829]-6829-0">Human factors training and education in healthcare</label></li><!-- [et_pb_line_break_holder] --><li><input type="checkbox" value="2048" name="group[6829][2048]" id="mce-group[6829]-6829-1"><label for="mce-group[6829]-6829-1">Integrating human factors into healthcare</label></li><!-- [et_pb_line_break_holder] --><li><input type="checkbox" value="4096" name="group[6829][4096]" id="mce-group[6829]-6829-2"><label for="mce-group[6829]-6829-2">Incident investigation and independent regulation</label></li><!-- [et_pb_line_break_holder] --></ul><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --> <div id="mce-responses" class="clear"><!-- [et_pb_line_break_holder] --> <div class="response" id="mce-error-response" style="display:none"></div><!-- [et_pb_line_break_holder] --> <div class="response" id="mce-success-response" style="display:none"></div><!-- [et_pb_line_break_holder] --> </div> <!-- real people should not fill this in and expect good things - do not remove this or risk form bot signups--><!-- 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