ࡱ> uwt RbjbjcTcT vZ>>I  GGT(eee}X,d'''''''$:+-JC'uTTTC'GGe}S'(& & & T(G8e}'& T'& & V&@&er'|Y& ''<(e&x&.&.&&.&,TT& TTTTTC'C'& TTT(TTTT&.TTTTTTTTT :   HYPERLINK "http://www.torontomeds.com/imagine/" \o "Home page"  INCLUDEPICTURE "http://www.torontomeds.com/imagine/img/v2logo-345x103.gif" \* MERGEFORMATINET  Executive Member Application Form COMMUNICATIONS CHAIR PART A: Information Date of Application (DD-MM-YY):  FORMTEXT        First Name:  FORMTEXT      Last Name:  FORMTEXT       Sex:  FORMCHECKBOX Male  FORMCHECKBOX  FemaleProfession-Specific Information Program:  FORMDROPDOWN Year of Program:  FORMDROPDOWN Contact Information Phone no. (Home):  FORMTEXT      Email:  FORMTEXT       Phone no. (Cell):  FORMTEXT       Address:  FORMTEXT      City:  FORMTEXT       Province:  FORMTEXT      Postal Code:  FORMTEXT      In Case of Emergency (Emergency Contact) Name:  FORMTEXT       Relationship to Applicant:  FORMTEXT       Phone Number: (Home):  FORMTEXT       (Work):  FORMTEXT       PART B: Roles and Responsibilities Communications chairs are responsible for keeping records of IMAGINEs development and disseminating information to the volunteers, stakeholders, and the public. One (1) position is currently open Duties include: Facilitating weekly group meetings and taking minutes of meetings Managing group resource archive and website Ensuring professionalism and consistency in IMAGINE presentations and publications Administering and providing training to volunteers and executive for chart management and other communication tools used in the Clinic or other IMAGINE initiatives Questions? Contact Nadine Lam:  HYPERLINK "mailto:nadine.lam@utoronto.ca" nadine.lam@utoronto.ca PART C: Questions  FORMTEXT       Why do you want to become an Executive Member of IMAGINE? (Max 250 words) What skills and experiences do you have that you believe would be an asset to IMAGINE? (Max 250 words)  FORMTEXT       How did you first hear about IMAGINE?  FORMDROPDOWN  If Other, please specify:  FORMTEXT       PART D: Volunteer Agreement & Signature All of the information contained in this application is true and the misrepresentation of any part of this application will be just and sufficient cause for termination of my volunteer placement. I understand that I am not an employee of IMAGINE and that any duties that I perform are as a volunteer. I am confident that I can successfully fulfill the expectations, as outlined in Part C of this application. BCD  # $  ߬߆zr_H_.H_3j%h}a5OJPJQJU\^JnH tH -jh}a5OJPJQJU\^JnH tH $h}a5OJPJQJ\^JnH tH h}anH tH h}aB*nH phtH h}a>*CJ8OJQJaJ81h6d5B*CJKH$OJQJ\aJmH phsH :jh6d5B*CJKH$OJQJU\aJmH phsH (h6d5CJKH$OJQJ\aJmH sH 1jh6d5CJKH$OJQJU\aJmH sH h}aOJQJ  \ bJ d$j&`#$/Ifb$okd~%$$Ifll&& t 6`j0&44 lae4 $d$j&`#$/Ifb$$a$ $d@&a$$da$  4 6 J L N X Z t v  ҝҝ{aG3j(h}a5OJPJQJU\^JnH tH 3j'h}a5OJPJQJU\^JnH tH h}anH tH 3j&h}a5OJPJQJU\^JnH tH 4jh}a5OJPJQJU\^JmHnHtH u3j &h}a5OJPJQJU\^JnH tH -jh}a5OJPJQJU\^JnH tH $h}a5OJPJQJ\^JnH tH h}a\  ekd&$$Ifl0l& t 6`j0&44 lae4 d$j&`#$/Ifb$   \ ^ ` | ~    @ B V |b|YKYjh}a5OJQJUh}a5OJQJ3j+h}a5OJPJQJU\^JnH tH -jh}a5OJPJQJU\^JnH tH 3j)h6d5OJPJQJU\^JnH tH $h6d5OJPJQJ\^JnH tH -jh6d5OJPJQJU\^JnH tH h}a^JnH tH h}anH tH h}a$h}a5OJPJQJ\^JnH tH   ^ ~d$j&`#$/Ifb$okd|($$Ifll&& t 6`j0&44 lae4^ ` u] d$j&`#$/Ifb$ d$j&`#$/Ifb$gd6dokd)$$Ifll&& t 6`j0&44 lae4  }kd$j&`#$/Ifb$kdj,$$Ifl0l& t 6`j0&44 lae4  h xx d$j&`#$/Ifb$okd -$$Ifll&& t 6`j0&44 lae4V X Z d f h v x   , ð{rrað{rSIh}a0JOJQJjh}a0JOJQJU j/h}a5OJQJUh}a5OJQJh}a3j .h}a5OJPJQJU\^JnH tH -jh}a5OJPJQJU\^JnH tH $h}a5OJPJQJ\^JnH tH h}a>*PJnH tH %jh}a5OJQJUmHnHujh}a5OJQJU j-h}a5OJQJU }ee d$j&`#$/Ifb$kd~.$$Ifl0l& t 6`j0&44 lae4 > r }ee d$j&`#$/Ifb$kd/$$Ifl0l& t 6`j0&44 lae4, . 0 : < > J L ` b d n p r t NPRh஝udZh}a^JnH tH !j12h}a0JOJQJU!j1h}a0JOJQJUh}a$h}a5OJPJQJ\^JnH tH !j0h}a0JOJQJUh}a0JOJQJh}a5OJQJh}a>*PJnH tH &jh}a0JOJQJUmHnHujh}a0JOJQJU!j40h}a0JOJQJU"r t }ee d$j&`#$/Ifb$kd1$$Ifl0l& t 6`j0&44 lae4 P}kd$j&`#$/Ifb$kd2$$Ifl0l& t 6`j0&44 lae4PRx d$j&`#$/Ifb$okdF3$$Ifll&& t 6`j0&44 lae4hj~24HJLVXZ\ln|h`O!jI6h}a0JOJQJUh}aOJQJ&jh}a0JOJQJUmHnHu!j5h}a0JOJQJUh}a0JOJQJjh}a0JOJQJUj4h}a0JUh}a5OJQJh}a$h}a5OJPJQJ\^JnH tH jh}a0JUmHnHuj3h}a0JU h}a0Jjh}a0JUx d$j&`#$/Ifb$okdG4$$Ifll&& t 6`j0&44 lae4Z\xeL ad$j&`#$/@&Ifb$ J$j&`#$/Ifb$ ad$j&`#$/Ifb$okdH5$$Ifll&& t 6`j0&44 lae4BDXZ\fhо{p{b{{Wj7h}aUjh}aUmHnHuj`7h}aUjh}aUh}a0JCJOJQJjh}aOJQJUh.OJQJhRh}aOJQJhROJQJh}aOJQJh}a0JPJ^Jh}anH tH h}ah}a5OJQJ&jh}a0JOJQJUmHnHujh}a0JOJQJU"}{vood$a$kd6$$Ifl0l& t 6`j0&44 lae4\O & FdEƀs`R & FdEƀs`gdR3TBjkigi05TY#&#$$d%d&d'd+D/NOPQ$a$ & Fd`O & FdEƀso` BFHdfhJKKLLM M MMMԟ󑏑~scsPcFsh}aOJQJ^J$j9h}aOJQJU\^Jjh}aOJQJU\^Jh}aOJQJ\^J h}a5CJOJQJ\^JaJUh}aCJOJQJ^JaJ%jh}a5OJQJUmHnHu jF9h}a5OJQJU jL8h}a5OJQJUjh}a5OJQJUh}a5OJQJh}a0JPJh}ajh}aUj@AKK@MBMMMnNNd@& d7$8$H$$a$d0e#&#$$d%d&d'd+D/NOPQI understand that it is my responsibility to update any addresses, emergency contacts or other changes to the information on this form. I consent to have a picture/videotape/interview of me for the purpose of obtaining material which may be used in a brochure, internet web page, news story, feature or broadcast for promotional material for the IMAGINE Clinic.  FORMCHECKBOX  Yes  FORMCHECKBOX  No If accepted as a volunteer I agree to follow the above. Name of Applicant: _______________________________________ Date ___________________________ DD-MM-YY PLEASE BE ADVISED THAT YOU WILL BE REQUIRED TO SIGN THIS APPLICATION AT A LATER DATE Signature of Applicant: ____N/A for Now_______________ Date _____N/A for now________ DD-MM-YY THANK YOU for applying to volunteer with IMAGINE. For additional information, please contact: Jennifer Galle and Meghan Ho Volunteer Email: HYPERLINK "mailto:imagine.volunteers@gmail.com"imagine.volunteers@gmail.com IMAGINE University of Toronto 1 King's College Circle, Room 2171A Toronto, Ontario, M5S 1A8 Directors: Sagar Dugani and Ryan McGuire MM4M6M8M:M@MM*NNNOOOOOP$PP>Q@QQQ巪{jbTLHLh}ajh}aUh}aCJOJQJ^JaJh}aCJ$aJ$ h}a5>*CJOJQJ^JaJh}a5>*CJOJQJaJ#h}aB*CJOJQJ^JaJphh}aCJOJQJ^JaJh}a5CJOJQJaJ h}a5CJOJQJ\^JaJh}aOJQJ^J$j0:h}aOJQJU\^Jh}aOJQJ\^Jjh}aOJQJU\^JNJOO$PPPQRRRRRR $d@&a$$a$d@& d7$8$H$ $d@&a$ QQQQRRRh}aCJOJQJaJh}aCJOJQJ^JaJh}ajh}aUh}a0JCJOJQJaJt+p 8,p 8-p 8.p 81h/R / =!"#n$n% 4 85 86 87 8%Dd ;  c ARv2logo-345x103IMAGINE - students promoting health logo""Home page"b#{7?aJ. cN#Don#{7?aJ. cNPNG  IHDRYg+PLTEBnQ T$W&Y)\)[+]+\-]._0`2b1`4c5d6e7f9g9g:g:h;h;i:gk>k?l@lAmBmBnCoDoEpFqIsHrIrLvKuNwNwMvMuNvQzR{T|W~V|Y~]\^b_`egejtrztw~}φԂʐٜؗܝܗԡݟڤߥߤܢתି᥷׬ܴ߬վ5d7f9h:h?lAnDpJtMwPyZ_ajnow΂}ɆϊӍ֑֔ؑљښۛٝէ঻ߥݨިڰवҳ~~~|||zzzxxxvvvtttsssqqqlll bKGDH cmPPJCmp0712Hs /IDATx^\ |TEAVu\

xcx>I8]$ f H@TTF@dB\9-fF 8 P̰6$!HABAΦCN_U~gwgaݝvC___}W}/j!B!B @!B!@U{EU)ʶUقa t!g} 5'i I%-~WW'N,`UIAعa<jAh"^bavjm5<8J7qi 8:Yo c!z&j S 4ZG{C|^=<*^Su WēAq{0"oFFX Q=4:aO>eU*OSgE}Y&z[B`bQo<#uë.Щ3]qV&=jZF5jՄi^bÌ_gUX::YoLQ'v5kC2zk`uQ򅷞P1o1p`s=zXVed?~w&?~M4%dV:@Я_ GkK5WɚldGF]XוX0L&p>pY5PEl35ccYJ1YYm@Q+Dž ԑ: z`"8jV;ï0')oAb@,4%  ,uln췂yӡDHhlU8Ew/cqGCT,K?-SFH·—HW$2D*} eDH :s̞Y?q@y08 2ga[Ҭ$22{ȱ eH{l;A(j{,}Loxz&V~v/T>@(g15{x}1Ba> kHc#~/V8 42÷JJ,7S #w$Ў3ĦǤ-u+OiquWb`-h^L<3|w*ydLBkx"rR3/8R R= Ȃ AX2P+Mx[Jt2Uun ~m#҄G#+ F}?ZbjqTfxk~n@x0,/MQ)JQh+9dejy9Eak,)K gAD|MVc co+%5N|12;={ZXD*_>C}?m?H}2Zp8i:GO {4ŀj9$2?"^2Z , J X"uR`/6mMy^I EW4 s Fk, m^?d SL1@"Lڔ#6TY@ f,b3!iɁ3LJuR=LOEA[(!ϋ86Ey|J2+ L"Lcx$ole,ٕP(L3ZoM/<0 j0"(uYK O Wļ@*~L-MSP2N/ŤCN*ԬimJ?ۃ=#(# tR+BpmaUT\o2X0/ {I0eL%~ wjF+ǡ`PGId WLeK)_$her ,>aMhdV %y=MopbM1TCƹThIVʊ4f~!,L&6(L)Xy6V/`>m/BȒ׵]HV̍Czt㤡e?elo_71^Ⱦ\4*#JELטIѭ7,a.7_}S(x];D)g.hXݯE% )$wr,׳_:0 y 5LAeee֧ Iʼn ~j!aY=!˙t7x YjbbF-Ks ;R49zoH5OُkW?˗Y)$*t}P6 hci#B,\#.oG=2K&u\>Ϗ̾e#j}o4|=XO2bV ]Q{A4(zF1T)Yl6+D0;p5"Ϊ= h8_%.S!M^%c0|ҋ#} kUkU֭10*l!˧r-s ̳V5RedN4q񵨅GqÐ\vPF7 #{6c yžyۋKmk&6@(2-Ȭ7zYg}.xk@mGQ1C郜sVu᛽vx*͈lਏo^ nE}<@ B=CȈtF YT! o˷6bJOjWW=Cr]21X}U|;sdԼ3QkQgYDq^dVƟIn˟ Y{DR,ͬӚ1,ҌLFԴH1f_@OXHG  ig" sZލ5bݡTro$ZNӮ-c0.?+f)\E-чpiSlw9pF',P viwYm22pDAhS-Ea&e|DF%Y_/rPԡO8yRI WPIKw.ݺ1-U4?*\VP gYil}WYD(Yuz>^m<,|2z(+F?P(ieM~p/=a%syr(iGg@1L$9dWxOp b uwUHR)[œ Zz ѧ&wZomא$.B3RОRJ2ZQY<&a"L6 &R@]嗨4hF;?7`<9 HePMZ݃'ɇ A?]4]3b DNDyR Yg%d-{%8Y;j P,*T*3(pnQpbCamAOr]ğŚxYDAEVY*iPz,"x]Sn>_kS ?r BxV:[d&p-8'o("K\őK`٥bRdddT&wUvo_Q-Ӱv5bǕ|?j%'Է!prNcH=~ \MGejꚋ)Ik?22f ?2޳̝bDC(q<`FqJNf+~N2MT_ՉwŐK! RPۂwP-'Ûy6dGJKY8q+?0 eHH;X<0q@N͏"bZX +ϧ1F6^^GĶJk>'mIk3߂kIfe,Wn/pHsRTN@&{J|D`W7d{~_AU(76pjcnB0flB͓:cePDv_D"'Zo+WdP /䆼lMKޠf7v,z,%= [MPæҧ c2>AzuO}*HJ< A}/ѶT(O_= Q !H,?W{O8q&=[d%+ {k#,94 9tAuͶ2(׆sch{%i b"e:6v}Bĭj|s3c Qn69kԱb#^{x bJUʵOB2n m)6wEK;M?yE;?hq.f~Y5 Ŷd9پ}[TRpzhEJYfAƗhF5X3ߩj-Z[񥡜}v6FaCnɗD Ɓ j|.;H4:>=t sR/Ьަi49@KUK^? #"H>";~+#>,u"s7-c"0v#׻c"$_:zy`?w|3슟2Zуd2PG?^3:wEboEըzymIVN5>dꕚ^ͳ(R7c!dH|?M9" >lRkz#,qԔqQТƥL9]Do)/Iq?}CV|)J $& lH<0-=2#~?v]3vD A< GֳsE|Jy >)Jlװ+N2{'D~XQ65Y6P. /:f*q~J}Vy:ɣgڮ4'#5s5:xꬶNr9<ߠ_AQ͕ٕ-ʳ~~Y(LxShΔ^v\i(UZ5SuWWe:+%Uз"Nd6\iRTamKB!z Ws^l m*rj[zjjaW7NdZ]-=<r:ɦywzWu浺aWVZU[{~Q~"q&z&Qitr?ӜvL n{BViklp1vY]ق+Kc-mNwŲ

Ah5}k8 =HP}ցMRN-ew 3݅h9EXoM.T6E צ9эCY:1=Ngܑ K:= ދ uB'@ǽ}9@Rd{;;Imt9dw@^*w!8䐵 h%p+.AYYXvg< x놧VBlSo M-cdőB[Ni*U}m!2Y2u7cf w#Q6edq^N+GA%φ#m:/.vs?&n[yC фz+jq|X.j${]aPRC:;ێ2¸nWYfz|Mb\xHWf{C:۰OV"$K.БvH[`]cdm va-W>\UjEX]xjg{?kQMfy%Zh\D%6b&,vJub/-U ?NٻI$f:BK7(p:Ъ8,n"E)!'QXD :IYQ <^Uq:\+*:H v}ɮٳsv|q+9>gFYmTyoWME]i5@DYmBKrw^v:ztbdm}HQ5Xm@nv_wUqυv'{`wFZ{7qmn]WzY~lwÍ|J$pwN^%. [z tbF9^ =vM- m-٪kwӴU\/& [nwoGu#Fm̥~۸6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ OJPJQJ_HmH nH sH tH J`J Normal dCJ_HaJmH sH tH h@h  Heading 1$$@&'5B*CJOJPJQJ\^JaJph6_h@h  Heading 2$$@&'5B*CJOJPJQJ\^JaJphO`@`  Heading 3$$@&5B*OJPJQJ\^JphODA`D Default Paragraph FontVi@V 0 Table Normal :V 44 la (k ( 0No List RR Balloon Text dCJOJ QJ ^J aJNN Balloon Text CharCJOJ QJ ^J aJd^d Normal (Web)ddd[$\$CJOJPJQJ^JaJtH *W!* Strong5\B@1B Placeholder Text B*phRYBR Document Map dCJOJ QJ ^J aJNQN Document Map CharCJOJ QJ ^J aJ@@b@ List Paragraph ^m$NU@qN Hyperlink#>*B* CJOJQJ^JaJo(phH H  No SpacingCJ_HaJmH sH tH 00 Style1 r\O\ Heading 1 Char'5B*CJOJPJQJ\^JaJph6_\\ Heading 2 Char'5B*CJOJPJQJ\^JaJphOTOT Heading 3 Char5B*OJPJQJ\^JphOPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] LL Z V , hMQR #*,\  ^  r PNR  !"$+BC$*?KQ_kqEQW`lr!Yekn I Y _ o s LXCFFFG$G$S S$FFFFFFFFFFFXFFS$FG$G$XH ,b$A6idKa>r]&# AA@0(  B S  ?LText16Text15Text1Check7Check8 Dropdown1 Dropdown2Text4Text3Text5Text6Text7Text8Text9Text10Text11Text12Text13Text18Text17 Dropdown3Text14Check3Check4@`FaYJ ` M +RrXs"l Z p M*/06IMIM3 HIIJMD'xÆMZ>δ>Fw8$U ^`OJQJo( ^`OJ QJ o(o p^p`OJ QJ o( @ ^@ `OJQJo( ^`OJ QJ o(o ^`OJ QJ o( ^`OJQJo( ^`OJ QJ o(o P^P`OJ QJ o(^`o(.^`.pL^p`L.@ ^@ `.^`.L^`L.^`.^`.PL^P`L.^`o()^`.pL^p`L.@ ^@ `.^`.L^`L.^`.^`.PL^P`L.MZ>>FwD'                           6dqx}a.RIK@p%%%%%%% Lh@h h hh @hhh,@hJUnknownPAF User G*Ax Times New Roman5Symbol3. *Cx Arial7K@Cambria7. [ @Verdana7.{ @CalibriI Interstate-LightG Interstate-Bold9 Webdings5. *[`)Tahoma?= *Cx Courier New;WingdingsA BCambria Math"qhf f!( !) $n20BCԇ2QHX $P6d2! xxJENNIFERJENNIFER   Oh+'0`x    ( 4@HPX JENNIFER4Executive Member Application FormCommunications.dot JENNIFER1Microsoft Office Word@Ik@@*@%!( ՜.+,D՜.+,, hp|  B  Title 8@ _PID_HLINKSAlqJ$mailto:imagine.volunteers@gmail.como m8mailto:nadine.lam@utoronto.cao'0$http://www.torontomeds.com/imagine/o  !"#$%&'()*+,-/0123456789:;<=>?@ABCDEFGHIJKMNOPQRSTUVWXYZ[\]^_`abcefghijkmnopqrsvRoot Entry F 'xData .:1TableL>.WordDocumentvZSummaryInformation(dDocumentSummaryInformation8lCompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q