SIGN-UP for PrEP Program (February) Thank you for your interest in signing up for the PrEP Program at Asian & Pacific Islander Wellness Center. All information entered here will remain STRICTLY CONFIDENTIALWhat is this?This is a program meeting once a week, that guides folks through the process of getting on PrEP We will be: Going through the basics of what PrEP is, including specific information about clinical trials and hormone interaction. Making your appointments for you Working with you 1-on-1 on how to pay for PrEP once you get your prescription, and generally how to get it for FREE! Teaching you how to refill your prescription Providing a full dinner every night! Giving you $50 of gift cards ...there for you every step of the way, and then some! Who is this for?Young Queer Men of Color (including Trans Men)ANDTrans WomenWhere is it?Downtown SF (TBD)When is it?Young Queer Men of ColorFebruary 2nd, 9th, 16th, & 23rd (Tuesdays)6:00p - 7:30pTrans WomenFebruary 3rd, 10th, 17th, & 24th (Wednesdays)6:00p - 7:30pSpaces are EXTREMELY LIMITED, so sign up soon! If you cannot make these dates/times, feel free to still fill this out and you will be given information about our next session Question Title * 1. Name First Last Question Title * 2. Zip Code Question Title * 3. Email Address Question Title * 4. Phone Question Title * 5. Are you a... Queer Man of Color Trans Woman Other (please specify) Question Title * 6. Age <18 18 - 29 30 - 44 45 - 59 60+ Question Title * 7. Are you of Hispanic or Latino origin or descent? Yes, Hispanic or Latino No, not Hispanic or Latino Question Title * 8. Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race? White Black or African-American American Indian or Alaskan Native Asian Native Hawaiian or other Pacific Islander From multiple races Some other race (please specify) Question Title * 9. Can you attend all 4 February sessions?(if you are a young queer man of color, your sessions are on Tuesdays)(if you are a trans woman, your sessions are on Wednesdays) Yes No Some but not all of them Other (please specify) Question Title * 10. Anything you'd like to let us know? (dietary restrictions, something you want covered specifically, questions, etc.) Done