National Black HIV/AIDS Awareness and Information Day Event Form - Minnesota Dept. of Health

Planning something for National Black HIV/AIDS Awareness and Information Day?

Contact the Minnesota Department of Health (MDH) once events are set-up so they can be listed on the MDH website's Statewide National Black HIV/AIDS Awareness and Information Day Calendar.

It is important that we receive your form by Thursday, January 28, 2016.

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 D8FCM 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 National Black HIV/AIDS Awareness and Information Day" (PDF) form by fax to 651-201-4000, or US Mail to:
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

Updated