Max Rady College of Medicine
Department of Community Health Sciences
Bold Ideas Colloquium Series
Fall/Winter 2017-2018
Speaker 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):
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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)
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Lay Abstract (100 Words):
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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 intergenerationally
Bold ideas on why and how to build, apply, link or blend theories to better inform programs and policy
Bold ideas on why and how to advance qualitative methodologies to better inform programs and policy
Bold ideas on why and how to best apply empirical techniques to better inform programs and policy
Bold ideas on why and how to advance rights-based approaches in family, community, public and
population health
Bold ideas on why and how social responsibility can advance family, community, public and population
health
Bold ideas on why and how health equity can advance family, community, public and population health
Bold ideas on why and how to advance diversity and inclusiveness for improved family, community,
public and population health
Bold ideas on why and how to realize and advance an indigenous lens in family, community, public and
population health research
Bold ideas on why and how to realize and advance a gender lens in family, community, public and
population health research
Bold ideas on why and how to bridge knowledges/disciplines for family, community, public and
population health
Bold ideas on why and how to link clinical epidemiology and the basic sciences to family, community,
public and population health
Bold ideas on why and how to advance family social science research to shift local to global family,
community, public and population health
Bold ideas on why and how to advance community development, locally, nationally and globally
through community health sciences
Bold ideas on why and how to “care” in the community health care system
Bold ideas on why and how to ethically approach public health genomics in the 21st century
Bold ideas on why and how to translate, communicate and mobilize knowledge to advance family,
community, public and population health
Bold ideas on why and how to rebrand community health sciences to engage family, community,
population and public health, locally and globally
Other bold ideas on why and how to …. (Please Specify):
List Three Learning Objectives (Limit 15 words per objective):
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2:
3:
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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.
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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 only
Adobe connect (outside university)
Prezi only
Video, specify:
Audio, specify:
Podium
Microphone
Other 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 supervisor
Supervisor’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
Director, Bold Ideas Colloquium Series
Bannatyne Campus
[email protected]
Ms Pamela Gordon
Bold Ideas Colloquium Series Coordinator
Bannatyne Campus
[email protected]
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