Planning something for World AIDS Day 2015?

Contact the Minnesota Department of Health (MDH) once events are set-up so they can be listed on the MDH website's Statewide World AIDS Day Calendar. Please complete the form below to submit to Roy Nelson. You can contact Roy via e-mail at: roy.nelson@state.mn.us.

It is important that we receive your form by
Tuesday, November 17, 2015 or sooner
.

Event Information

Name(s)

Organization

Address

City

State

Zip

Phone

Fax

E-mail

Agency Website

Provide the title of the event:

Describe the event (purpose, who should attend, attach promotional flyer or press release):

Dates, times, and location for the events:

Any costs, reservations, etc., required to attend event (if so, how much or who to contact to register):

Any other details about the event:

To prevent abuse of this form, please type the following letters/numbers HSVB4 into the field below. Thank you.
required


Please PRINT this form as a confirmation prior to pressing "Submit Event." Thank you.



If you have technical difficulties with this order form, submit the "Planning Something for World AIDS Day" (PDF) form to Roy Nelson at MDH by calling (651) 201-4027, Fax: (651) 201-4000, e-mail: roy.nelson@state.mn.us, or US Mail:

Minnesota Department of Health
Infectious Disease Epidemiology, Prevention and Control Division
STD, HIV and TB Section
Freeman Office Building
P.O. Box 64975
St. Paul, MN  55164-0975
ATTN: Roy Nelson

Updated