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 AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe 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. CommentsThis field is for validation purposes and should be left unchanged.