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HIV Testing Day Event Submission Form

HIV Testing Day Activity/Event Submission Form
Fields marked with * are mandatory:
*

  (Use xxx-xxx-xxxx format.)  
*
* (Use xxx-xxx-xxxx format.)
*
NHTD Event
*
* *
(Use mm/dd/yyyy format.)
      (Use mm/dd/yyyy format.)
*


               
Will onsite testing be provided?
If yes, will rapid test be provided?
 

Disclaimer: Events submitted will be listed on the Web site at our discretion. We reserve the right to not list events. Please allow at least 3 business days from date of submission for events to be posted.