Application Form
Global Health Institute - Thailand 2015
Researchers Conference of
“Emerging disease at convergence of animal, human and environment health”
Faculty of Veterinary Medicine, Chiang Mai University, Thailand
2nd – 20th February, 2015
ComAcross - One Health in Asia
1. Information of Participant
*Given name
*Last name
*Preferred Written Name
*Organization
*Country
*Contact Number
*Email Address
*Type of organization
□ Industry
□ Government Sector
□ University/ Educational Institute
□ Student
□ NGOs
*Professional
□
Medical
□
Food Science
□
Veterinary
□
□
□
Social Science
Economic
Other
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2. Please see the details of offered courses in GHI 2015;
WEEK 1
2 – 6 FEB
WEEK 2
9 – 13 FEB
Pre-conference: Training Course
Course1: Global Health
Leadership: the convergence at
animal, human and the
environment
5 days (2 -6 Feb)
Conference:
“Global Health Conference for
Researchers in emerging
disease at the convergence of
animal, human and
environmental health”
 Emerging and Reemerging diseases
 Antimicrobial
resistance
 Application of risk
analysis
 Epidemiological tools
and application
 Food safety and
hygiene
 One Health Education
for Asia
Course 2: The Global Burden of
antimicrobial resistance
3.5 day (3 - 6 Feb)
Course 3: Participatory
Epidemiology Approach to One
Health – EcoHealth
(Introduction)
5 days (2 -6 Feb)
Course 4: Environmental Health
5 days (2 – 6 Feb)
WEEK 3
16 – 20 FEB
4 days
Post-conference: Training Course
Course 5: Farm to table field
study
5 days (16 – 20 Feb)
Course 6: Food safety risk
analysis
5 days (16 – 20 Feb)
Course 7: Epidemiological,
economical and ecological
components for One Health
5 days (16 – 20 Feb)
Course 8: Introduction to GIS
5 days (16 – 20 Feb)
Course 9: Participatory
epidemiologic approaches to
One Health – EcoHealth 2
(Community Base)
5 days (16 – 20 Feb)
REMARK:
 At least 10 participants are needed per course. We have right to cancel the course
which has less 10 participants.
 Eligible for academic credit
Package
Detail
Package A
Conference + Pre and Post conference courses
Package B
Conference + 1 Pre conference course
Package C
Conference + 1 Post conference course
Conference only
Training course only
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3. *Which package do you prefer?
□
Package A
□
Package B
□
Package C
□
Conference only
□
Training course only
If you select training course, please specific your preference.
4. Please specific the other 3 most preference courses in case your selected course
are closed due to less 10 participants by putting digit 1-3 in front of the offered
course.
(1 = most 2 = fair 3 = weak)
Pre-Conference week (2-6 February 2015)
Course 1: Global Health Leadership: the convergence at animal, human and the environment
Course 2: The Global Burden of antimicrobial resistance
Course 3: Participatory Epidemiology Approach to One Health – EcoHealth (Introduction)
Course 4: Environmental Health
Post-Conference week (16-20 February 2015)
Course 5: Farm to table
Course 6: Food safety Risk analysis
Course 7: Epidemiological, Economical and Ecological Components for One Health
Course 8: Introduction to GIS
Course 9: Participatory epidemiologic approaches to One Health – EcoHealth 2 (Community
Base)
5. Conference (9-13 February 2015)
□ Oral Presentation
□ Poster Presentation
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6. Food Restriction
7. Special Request
-Thank you very much-
Please send the filled out application form to
Email: vphcap@gmail.com
or Fax: (66) 053-94 8072
Attn: Ms. Warisara Sukumolchan
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