Planning something for NLAAD 2012?

Contact the Minnesota Department of Health (MDH) once events are set-up so they can be listed on the MDH website's Statewide NLAAD 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 Friday,��September 28, 2012.


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 RK9WB 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 NLAAD " (PDF: 16KB/1 page) 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 and HIV Section
Freeman Office Building
P.O. Box 64975
St. Paul, MN  55164-0975
ATTN: Roy Nelson

Updated