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 31, 2013.


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 QV6X4 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 and HIV Section
Freeman Office Building
P.O. Box 64975
St. Paul, MN  55164-0975
ATTN: Roy Nelson

Updated