CHI Events & Training Submission Form

For Centre Use Only - Completion of this form is required for all CHI events.
 

*1) THE PURPOSE OF THIS EVENT SUBMISSION IS TO:

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SECTION A: If you are REPORTING YOUR EVENT DETAILS for the CHI Training Tracker, please complete the following section.
Please remember to provide the Training, Education and Event Coordinator (Amanda Osorio) with a copy of your Event Sign in Sheet after your event (found at http://chimb.ca/events/eventform).
 

2) Event Lead (Organizer)

3) Platform Hosting Event

4) Event Title

5) Date(s) of Event

6) Delivery method:

7) Which key stakeholders participated in the development of this training event?

Event organizers must have participants sign in on provided CHI sign in sheets and must be submitted to the Training, Education and Event Coordinator after the event.
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SECTION B: If you are REQUESTING ASSISTANCE with coordinating and/or promoting your event, please complete for following section.
Completion of this form is recommended TWELVE WEEKS before your event to facilitate coordination of event.
Please remember to provide the Training, Education and Event Coordinator (Amanda Osorio) with a copy of your Event Sign in Sheet after your event (found at http://chimb.ca/events/eventform).
 

EVENT/TRAINING COORDINATION

8) Event Lead (Organizer)

9) Email Address

10) Phone Number

11) Program Lead/Chair

12) Platform Hosting Event

13) Event Title

14) Date(s) of Event

15) Location:

16) Delivery method:

17) Which key stakeholders participated in the development of this training event?

18) I have special requirements for my event and would like assistance with booking a location. I would like:

19) If requesting assistance with room booking - desired site/location:

20) If requesting assistance with room booking - choose alternate dates in case of reduced room availability:

21) This is a recurring event:

22) Event start time:

23) Event end time:

24) Maximum number of registrants:

25) Event Description for Poster (two to three lines):

26) Names of Presenter(s)/Speaker(s):

27) Poster content:

Anything you want featured on the poster -speaker bio, learning objectives, etc. - max word count 150:

28) Approved Speaker Photo:

29) This event has a:

30) My event requires registration:

31) If yes, is there a fee for registrants?

32) What is the registration fee for your event?

33) If having pre-registration, registration should open on:

34) Pre-registration should end on:

35) Audio Visual (AV) Equipment Requirements - I will require the following for my event:

36) Audio Video (AV) Equipment Quantity Requirements - I will require the following for my event:

37) Audio Visual (AV) Services Requirements - I will require the following for my event:

38) Accreditation:

39) Event Handouts:

40) Additional Needs:

41) Food/Refreshments:

With the new restriction against the ordering of food for events, we have been moving away from this option. Exceptions may include if cost of food is covered by the event's registration fee. If you meet these requirements and would still like to proceed with ordering food, please complete the approval form and submit to Holly Madden (Holly.Madden@med.umanitoba.ca) a minimum of three weeks prior to the event. (Food must be ordered at least one week in advance of your event. Menu and ordering information can be found here.)
Event organizers must have participants sign in on provided CHI sign in sheets and must be submitted to the Training, Education and Event Coordinator after your event.

COMMUNICATIONS

42) Target Audience for event (check all that apply):

43) Event Category:

44) Web Content

45) Please promote the event through:

EVALUATIONS: An electronic survey will be emailed to your event participants and a report will be provided after the evaluation closes (1 week post-event). Evaluations are used based on event format (course/workshop/seminar, etc) and consist of standard CHI eval questions.  If you would like to make changes/additions to the questions, please submit to Mercy-Anne Magundayao 1 week prior to your event.  A list of the generic questions can be found at chimb.ca/events/eventform.  If preferred to have paper-based evaluations, event leads can also input paper evaluation responses into the electronic link provided. Please note the event lead will be responsible for that data entry. Communications will provide the summarized report.

46) Event has been approved by:

47) Any other questions or comments/additional information?


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