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HIV Training Registration Form

January—June 2010

First Name:

Middle Initial:

Last Name:

Organization:

Department:

Title:

Check if Home Address:

Address:

City:

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Zip:

Phone:

Fax:

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County You Work In:

1. Check off trainings you wish to attend. All trainings will be held in Syracuse, NY.

	Overview of HIV Infection and AIDS (January 15, 2010)
	HIV/AIDS Confidentiality Law (January 22, 2010)
	HIV Testing in NYS: 2005 Guidance (February 9, 2010)
	HIV Testing: Skills Practice Session (February 11, 2010)
	Improving Health Outcomes for HIV+ Individuals Transitioning from Correctional Settings to the Community (February 23, 2010)
	Addessing Sexual Risk with Drug Users and Their Partners (March 19, 2010)
	Reducing the Risk and Harm of HIV (April 14-16, 2010)
	Promoting Primary Care and Treatment Adherence for HIV+ Individuals (May 27, 2010)
	HIV & STDs (June 3, 2010)
	Building Bridges to Cultural Competency (June 7, 2010)
	HIV and Hepatitis C Co-Infection (June 15, 2010)
	What's New in HIV/AIDS (June 17, 2010)

	2. Number of Years in Current Occupation:

	3. Primary Work Setting:

	4. Primary Occupation:

	5. Educational Level:

	6. Ethnicity:

	7. Race:

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