5th Annual Arizona Integrated HIV Symposium

The HIV Symposium will be held at Black Canyon Conference Center in Phoenix. Registration is required for attendance. 

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* 1. First Name

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* 2. Last Name

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* 3. Name as you would like it to appear on your nametag

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* 4. Agency/Entity you are affiliated with

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* 5. Primary job title, occupation or role

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* 6. City (either work or home)

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* 7. County (or State if outside of Arizona)

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* 8. Email

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* 9. Day Two (March 27) will be comprised of planning entity updates and planning activities soliciting input on the HIV Integrated Plan for Arizona.  The afternoon of Day Two will be specific to those who contract with ADHS- Prevention or Ryan White Part B or with Maricopa County- Ryan White Part A. If you do not have a contract with one of these programs, you do not need to attend the afternoon of Day Two. If you have a contract with any of these programs, it is mandatory that the program have representation on Day Two.  
I will be attending:

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* 10. If you are funded by ADHS or Ryan White Part A , which program is your position funded by? Check all that apply.

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* 11. Will you be attending the Pre-Symposium Workshops on March 25?  Each workshop will be full day (although end times may differ slightly). Question 12 will ask for your choice of workshop.

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* 12. Which Pre-Symposium Workshop will you attend? (Please choose only one) Seating will be limited in the workshops. Those that reach capacity will be marked as closed.

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