HIV Persistence Workshop

Request for Registration Form

Name*
First Name*
Institution*
Address 1*
Address 2
ZIP*
City*
Country*

Phone
Fax

E-Mail*

Did you attend the previous workshop?

Are you submitting an abstract this year as author or coauthor?*

Are you actively involved in research in the HIV field, or clinical research?*

Do you regularly treat individuals infected with HIV?

Do you provide treatment guidelines to clinicians, community groups, or agencies?

Do you represent a community-based group actively involved in the HIV field?

Are you ready to pay the registration fees and found support for your travel?*

Buy sending this form I engage myself & I understand that final acceptance of my registration will depend of the organizing committe

* Required Fields