ADD YOUR NLAAD 2020 EVENT

Please provide us with your event information. If you are in need of support obtaining HIV tests please also complete the request form on the 2nd page of this survey

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* 1. EVENT TITLE

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* 2. HOST ORGANIZATION(S), PLEASE INCLUDE ANY PARTNERS YOU MIGHT BE COLLABORATING WITH, INCLUDING YOUR ORGANIZATION

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* 3. EVENT DESCRIPTION

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* 4. EVENT DATE AND TIME

Date / Time

Date

Time

AM/PM

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* 5. CONTACT PERSON

Name and title

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 6. EVENT LOCATION

Name of location where the event will happen

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

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* 7. WILL THERE BE HIV TESTING AT YOUR EVENT?

Yes

No

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* 8. WHAT IS THE TARGET NUMBER OF TESTING FOR THIS EVENT?