2010 Workplace Health Promotion Symposium

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Healthy Minds Matter: Taking Action
Workplace Health Symposium

When: March 3 - 4, 2010
Where: 89 Chesnut Conference Centre, 89 Chestnut St. Toronto, ON, M5G 1R1
Time: 8:30-4:00 pm
Cost: 85$/Day, 170$ for both days (paid by cheque or money order only)

Online Registration FORM

Participant Information
First Name
Last Name
Organization
Job Title
Sector	Public Health Occupational Health and Safety Council of Ontario (OHSCO) and Associates Public Sector Non-Governmental Organization (NGO) Private Sector Large Business Employer (100 employees+) Private Sector Small Business Employer (less than 100 employees) Union/Organized Labour Workplace Health Service Provider (other than Public Health) Workplace Health Academia/Research & Other
Street Address
City
Postal Code
Region	North East Central East Toronto Central West South South West Out of Province Out of Canada
Province
Telephone
Tel. Extension
Fax
Email
I require special consideration due to a lack of mobility. If so, please explain
I require special considerations for meals (e.g. vegetarian, vegan, food allergies)? If so, please specify
Attendance Information
Attendance	I will attend the day sessions for both days (recommended) $170.00 I will only attend the THCU day session for Wednesday March 3, 2010. $85.00 I will only attend the OHWC day session for Thursday March 4, 2010. $85.00
Payment	I will pay my attendance fee in advance by: Cheque Money Order   Note: Pricing quoted above Please send cheque or money order payable to: University of Toronto The Health Communication Unit, c/o Barry MacDonald, Dalla Lana School of Public Health 155 College Street, Room 500 Toronto, ON, M5T 3M7 Note: Cheques that are returned will be subject to a $25.00 administration fee. Registrations cancelled 2 weeks or more in advance of the event will be refunded in full minus an administration fee of $12.50. Registrations cancelled less than 2 week prior to the event will be refunded 50 % of fess paid minus an administration fee of $12.50.
Accommodation Information
Accommodation	Note: A group room rate of $135/night has been reserved for Tuesday March 2nd and Wednesday March 3rd at the Metropolitan Hotel, 108 Chestnut Street, Toronto, ON, M5G 1R3, located across the street from the venue.  Hotel reservations are to be made by the participant. Please call the reservation desk at (416) 977-5000 and quote the event 'Workplace Health Symposium'. Payments will be made directly to the hotel. Please ensure that you book your accommodations by January 31, 2009 to receive the special room rate. After that date, room prices will be the best rate available on that day. Please indicate your intention to reserve accommodation: I do not require accommodation. I am booking accommodation for Tuesday March 2, 2010. I am booking accommodation for Wednesday March 3, 2010. I am booking accommodation for Tuesday March 2, 2010 and Wednesday March 3, 2010,
Additional Information
Photo Consent (optional)	I hereby consent to the videotaping/photographing/audio recording of myself at the THCU/OHWC Building Healthy Workplaces Symposium March 3 & 4, 2010. I understand that all material obtained will be used by the THCU &/or the OHWC for educational and related purposes, including external distribution via website, satellite broadcast, cable TV, radio broadcast, webcast or on-demand streaming in digital format on the Internet. THCU &/or OHWC may also share this material with others, as appropriate. I understand that I will receive no compensation for my consent. I understand that use of the Photographs & Recordings may include, but is not limited to, the following: - Internal use by THCU &/or the OHWC and other institutions in streaming digital (live or on demand) on the Internet or other digital media. - Distribution (may include videotape reproduction, satellite broadcast, cable TV, webcast, on-demand, website or print). I agree to provide to the THCU (Centre for Health Promotion at the University of Toronto) and the Ontario Healthy Workplace Coalition with a non-exclusive right to create recorded presentations; a non-exclusive, perpetual, irrevocable, world wide, fully paid-up, royalty free license to use, copy, adapt, modify, translate, publish including on its own intranet, distribute, and to incorporate into derivative works, all or any part of the Photography and Recorded materials for educational purposes and to authorize others to do so on behalf of Ontario. I hereby expressly, irrevocably and without restriction, grant a partial waiver of any moral rights that I may have in the recorded presentation in favour of THCU, CHP at the University of Toronto and the Ontario Healthy Workplace Coalition. I have read this form and have the opportunity to ask questions about the project. I agree to be bound by this consent form. I agree
To better suit your needs please take a moment and fill out the remaining questions below: What are the top three programs or services you deliver in workplace health promotion: i) ii) iii) If applicable, please provide the website/url address for your workplace health promotion information: For networking and partnership development purposes we would like to distribute a delegate contact list (with names, organization, job title and phone number - but no email addresses) to participants who are agreeable. Are you willing to provide to share this information? Yes No The panel discussion occurring on March 3rd has people from private and public sector organizations working in either large or multi-site organizations talking about some of the challenges they have faced (or are facing) and what they have done to deal with/address these challenges/what they have learned. Please list up to three questions you would like to see posed to members of the panel: i) ii) iii) Thank-you!

The Workplace Health Promotion Symposium has been organized by the Capacity Building Standing Committee of the Ontario Healthy Workplace Coalition, and The Health Communication Unit’s Supporting Comprehensive Workplace Health Promotion in Ontario Project, through funding from the Ontario Ministry of Health Promotion.

Contact Us

For more information, please contact Jessica Elgie, at 416-978-0595 or jelgie@thcu.ca.