Abstract Proposal Form 2019 LGBT HWC Conference Abstract Submission First Name*Primary presenterLast Name*Primary PresenterEmail*Primary Presenter Degree(s)*Primary Presenter Examples: B.A., M.P.H., M.D., P.A.-C. Please also include your field of study, if applicable (e.g., Ph.D. psychology). If you are currently enrolled in a degree-granting program, please indicate that here (e.g., high school student, B.S.N. student, M.D. student).Title(s)*Primary PresenterAffiliation*Primary PresenterRace / Ethnicity*Primary Presenter (check all that apply) Asian Black / African-American Native American / Alaskan native Hispanic / Latino White Other Specify if OtherGender Identity*Primary PresenterFemaleGender non-conformingMaleTransgender ManTransgender WomanOtherSpecify if OtherSexual Orientation*Primary PresenterBisexualGay / LesbianStraight / HeterosexualOtherSpecify if OtherTelephone*Primary PresenterAddress*Primary Presenter Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Additional Presenters/AuthorsPlease list co-presenters/authors, their degrees, their primary affiliation, race/ethnicity, sexual orientation, and gender identity in the following format: Jane Smith, R.N. (New York University School of Nursing) Latina lesbian woman No more than 2 co-presenters for oral presentations. There is no limit to the number of co-authors on poster presentations.Abstract Category*ResearchEducational InnovationBest PracticesTopic ReviewSubmission Type*Please indicate for which type of presentation(s) you would like your abstract considered.Panel PresentationPoster PresentationPanel and/or Poster PresentationsAbstract Title*Intended Audience*Select all that apply Pre-Health Professions Students Pre-Health Advisors Health Professions Students Faculty Educators Clinicians Activists Other Learning Objectives*Maximum 700 characters (approximately 100 words)Abstract Body*Maximum 2450 characters (approximately 350 words)CV uploadIf submitting for Panel Presentation, please upload CV for primary presenter and co-presenter. Files can be in MS Word format or PDF format. Drop files here or Accepted file types: pdf, doc, docx. NameThis field is for validation purposes and should be left unchanged.