Max Rady College of MedicineDepartment of Community Health Sciences

Bold Ideas Colloquium SeriesFall/Winter 2017-2018Speaker Registration Form

Primary and Co-Presenter Information:

First name/Last name:

Organization:

Unit/Centre/Program:

Email address:

Telephone number(s):

List Co-Presenters (if applicable):

Mark an X to indicate whether you are a:

___ Faculty member ___ Medical Resident ___ Research Fellow/Associate ___ Graduate Student

___ Member of a Community Organization

Speaker Biography (Limited 3 Sentences): \

Talk Details: Please limit talks to 25 minutes to allow for questions, debate and critical reflection. For the Edge of Medicine Series, talks are extended to 45 minutes.

Title of Talk (10 Word Limit) \

Lay Abstract (100 Words): \

1

Thematic Area(s) (Check all that apply): Where possible, we will align presentations with the Community Health Sciences/Family Social Sciences fall and winter course offerings. Please check which thematic area(s) your talk falls under.

Bold ideas on why and how to advance population and public health across the life course and inter-generationallyBold ideas on why and how to build, apply, link or blend theories to better inform programs and policyBold ideas on why and how to advance qualitative methodologies to better inform programs and policyBold ideas on why and how to best apply empirical techniques to better inform programs and policyBold ideas on why and how to advance rights-based approaches in family, community, public and population healthBold ideas on why and how social responsibility can advance family, community, public and population healthBold ideas on why and how health equity can advance family, community, public and population healthBold ideas on why and how to advance diversity and inclusiveness for improved family, community, public and population healthBold ideas on why and how to realize and advance an indigenous lens in family, community, public and population health researchBold ideas on why and how to realize and advance a gender lens in family, community, public and population health researchBold ideas on why and how to bridge knowledges/disciplines for family, community, public and population healthBold ideas on why and how to link clinical epidemiology and the basic sciences to family, community, public and population healthBold ideas on why and how to advance family social science research to shift local to global family, community, public and population healthBold ideas on why and how to advance community development, locally, nationally and globally through community health sciencesBold ideas on why and how to “care” in the community health care systemBold ideas on why and how to ethically approach public health genomics in the 21st centuryBold ideas on why and how to translate, communicate and mobilize knowledge to advance family, community, public and population healthBold ideas on why and how to rebrand community health sciences to engage family, community, population and public health, locally and globallyOther bold ideas on why and how to …. (Please Specify):

List Three Learning Objectives (Limit 15 words per objective):1:2:

2

3:

Presentation Date(s) (Check 4 possible dates): From the schedule (located on the webpage), list four possible presentation dates. We ask that you reserve these dates, and from the four, we will select one. Because we will advance advertise, we ask that you formerly commit to the date selected.

1. dd/mm2. dd/mm3. dd/mm4. dd/mm

Software, equipment, or other requests (Check all that apply): Double click on the box you want to check. A check box forms options field menu will pop up. In the upper right hand corner, titled default value select checked.

Power point only Keynote onlyAdobe connect (outside university) Prezi onlyVideo, specify:Audio, specify:PodiumMicrophoneOther accommodation requests, please specify:

Advertising (Check if submitted): We will advertise the Bold Ideas Colloquium Series via email, paper posters, website event postings, or other communication venues. To help facilitate event promotion, please feel free to provide a JPEG-format photograph of yourself (head shot preferred). The photo should be publication quality if possible.

Photograph submitted with registration form

Acknowledgements: All presenters will receive a letter acknowledging their participation in the series. Please indicate below if you would like a copy of the letter sent to your supervisor.

Send to Supervisor Do not send to supervisorSupervisor’s First/Last Name:Email Address:

Videotaping/Photographing: In some of our talks we may videotape and/or photograph sessions. We will ask presenters and moderators to sign a standard University of Manitoba video/photograph consent form.

Submit forms or for further information, contact:

Dr. Brenda Elias Ms Pamela GordonDirector, Bold Ideas Colloquium Series Bold Ideas Colloquium Series CoordinatorBannatyne Campus Bannatyne CampusBrenda.Elias@umanitoba.ca Pamela.Gordon@umanitoba.ca

3