Legacy & Future Frontiers Proposal Submission

SUBMITTER
First Name *
Email Address *
Phone *
Session Chair *
SESSION INFORMATION
The Legacy & Future Frontiers sessions will honor the legacy of The Toxicology Forum's founders and early members whose work and contributions influenced the current field of toxicology, public health, and environmental policy. The sessions will explore how their influence continues to guide the future of the field. Each 30-minute session will consist of two 10-minute presentations followed by 10 minutes for questions. SPEAKER 1: Legacy: An overview of the research and influence of the legacy member. The preference is for the legacy member to present in person or, if necessary, via a prerecorded 10-minute video. If neither is an option, a current member working in the same area who was influenced by the legacy member may present in person. In some cases, the Future Frontiers speaker may present both portions. SPEAKER 2: Future Frontiers: A talk presented in person by a scientist highlighting their current work that builds on the legacy member’s contributions, and how it will guide the future of toxicology research and public health and environmental policy over the next 50 years. Early career scientists are encouraged to present!
SESSION SUMMARY STATEMENT
Please describe the rationale for this session—what research area will be discussed, how it has evolved, what (if any) policies it has influenced, and how it may shape the future of toxicology.
Rational Statement *

SPEAKER INFORMATION
SPEAKER 1: LEGACY

Legacy Member First Name *		Legacy Member Last Name *
Legacy Member Email Address *
Legacy Member Phone *
_________________________________________

LEGACY MEMBER ATTENDING
Will the Legacy Member present their own research summary in person?
A. *	Yes No
LEGACY MEMBER NOT ATTENDING
If the Legacy Member is not attending, will they provide a 10-minute recorded video for their portion of the presentation?
B.	Yes No
LEGACY MEMBER NOT ATTENDING/NOT PRESENTING
If the Legacy Member is not attending and not submitting a prerecorded video, who will be Speaker 1?
Speaker 1 Alternate: First Name		Speaker 1 Alternate: Last Name
Speaker 1 Alternate: Email Address
Speaker 1 Alternate: Phone
_______________________________________________

SPEAKER 2: FUTURE FRONTIERS

Speaker 2: First Name *		Speaker 2: Future: Last Name *
Speaker 2: Email Address *
Speaker 2: Phone *

TRAVEL SUPPORT
Legacy Speaker Funding
There are limited funds available to assist with travel expenses where there is need. Would the Legacy Member like to be considered for travel assistance?
C. *	Yes No
Legacy Justification
If travel reimbursement funds are desired, please provide a justification.
D.
Early-Career Speaker Funding
The David Miller Awards Program supports efforts to increase the pipeline of emerging scientists who value enhancing knowledge through dialogue.  If the Future Frontiers presenter is an early-career researcher, would they like to be considered for travel assistance?
E. *	Yes No
Early-Career Justification
If travel reimbursement funds are desired, please provide a justification.
F.
Unmet Travel Needs
If there will be additioanal unmet travel needs or expenses, please explain.
G.

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