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HIV/AIDS Action Summit Form

Yes, we would like to participate as a Community Partner in the San Gabriel Valley HIV/AIDS Action Summit.  We approve our organization's name and/or logo to be used on publicity and programs for the event and will agree to assist in publicizing and inviting others to attend the event.

We would like our organization to be listed as indicated below:
(If you are attending as an individual only, you can also fill out this form to RSVP): 

Attendee Status*

Organization or
Attendee Name
*

Mailing Address*

City* 

State*

Zip Code

Contact Person
(Main contact for your organization)

Phone*

Email Address*

Choose a Workshop*
(For surveying purposes, choose a workshop you'd be interested in attending the most)
Logo Attachment (Under 1MB)
(Applicable only if you are signing up an organization)

* Required Fields

 
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