Our Faith Lights The Way - 1000 Congregations Sign-up event registration

Individual Registration

Please enter information in the form below to process registration for event Our Faith Lights The Way - 1000 Congregations Sign-up.

First name*

Last Name*

Organization*

Address*

City*

Country*

State*

Zip*

Phone*

Email*

Website Address

Mobile Phone

Leader's Name

Leader's Title

Contact Person

Please select the religious affiliation that your congregation represents*

Tell Us About Your Event

Is this your first time hosting an HIV Testing event?

If no, how many years have you hosted an event?

Will you need technical assistance?

For a Coalition of Congregations - Our Coaltion will

Organize a one-time community-wide event with HIV testing as the focus

Organize a one-time community-wide event where HIV testing is one of the many screenings offered

Host a series of HIV testing events throughout the month of June

Other

Additional screenings to be offered (check all that apply)

STD

additional tests will not be offered

Congregational Size

Mobile Telephone*

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