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Office of HIV Psychiatry, American Psychiatric Association
1000 Wilson Blvd., Suite 1825, Arlington, VA 22209
703-907-8668 www.psych.org/aids

* 1. My contact information:

* 2. Indicate topics of interest:

* 3. Indicate specific population groups of interest:
(Check all that apply.)

4. Indicate the anticipated audience size:

5. Indicate the meeting/program type:

* 6. Proposed training location:

* 7. Preferred timeframe (ex. Noon - 3 pm):

* 8. Dates and times available:
We will work to accommodate your preferred training date pending faculty availability.

9. Comments/questions:

*Please note: Training modules and other HIV psychiatry resources and materials are available to download for free at www.psych.org/aids.