HIV Testing Day Activity/Event Submission FormBy Findstdtest HIV Testing Day Activity/Event Submission Form Fields marked with * are mandatory: Organization: * Web site: Phone Number: (Use xxx-xxx-xxxx format.) Ext: Fax Number: Contact Name: * Contact Phone: * (Use xxx-xxx-xxxx format.) Ext: Contact E-mail: * NHTD Event Name: * Description: Start Date: * End Date: Event Time: * (Use mm/dd/yyyy format.) (Use mm/dd/yyyy format.) Address: * City: State: –Select–AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP: Will onsite testing be provided? Yes No If yes, will rapid test be provided? Yes No Audience(s) served: 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.
