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. Please complete the form below to submit to Roy Nelson. You can contact Roy via e-mail.

It is important that we receive your form by Thursday, January 29, 2015.

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 2W46K 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: 11KB/1 page) form to Roy Nelson at MDH by calling (651) 201-4027, Fax: (651) 201-4000, e-mail

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