Thank you for your interest in the NY/NJ AETC training event.
 
Event Title:Initiation of HIV Antiretroviral Therapy
Date:10/23/2013
 
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 Unique ID Number. Your Unique ID number is the first two letters of your first name, the first two letters of your last name, the month of your birth, and the day of your birth, plus the last four digits of your social security number. For example: John Smith, May 29 123-45-6789 would be JOSM05296789
 

PIF ID:  
FN FN LN LN M M D D # # # #
Name Birth Last 4 SSN
 
First Name:    * required
Last Name:    * required
Email:    * required
Employer/Agency: