Thank you for your interest in the AETC training event.
 
Event Title: 2013 WHICC Recording Session 4 - Toward Eliminating HIV Heterosexual Transmission
Date: 01-Jul-13
 
We collect information from each participant in our training activities using the Participant Information Form (PIF). To complete your registration, please follow the instructions below to create or update your Participant Information Form (PIF).
Please fill in your PIF Unique ID Number. Use the month of your birth, day of your birth, and last four digits of your SSN. For example, (May 29, 123-345-6789, has the ID number 05296789. Why is this necessary This program is part of the Texas/Oklahoma AIDS Education and Training Center, a federally funded training program.  Because of the government funding source, we need to account for every person who receives training, as well as the number of people who attend multiple trainings.  Please note that this unique identifier does not allow for identification of individual respondents.  As indicated on the form, please create your anonymous PIF unique identification number by entering the month and day of your birth, and the last 4 digits of your Social Security number.
 

PIF ID:  
M M D D # # # #
Birth Last 4 SSN


 
We collect the following information solely for the purpose of facilitating the on-line registration process for our events. This information is not stored with or connected to your unique PIF ID.
 
First Name:    * required
Last Name:    * required
Email:    * required
Employer/Agency:  * required
Profession
PhysiciansPhysician AssistantsAdvanced Practice NurseNurses
DentistsPharmacistsRegistered Dental HygienistOther
Degree/Credentials:  
What is your age range? < 25
25-34
35-44
45-54
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