APP Community Forum Registration Form

IDSA and HIVMA launched a new community forum for its Advanced Practice Provider members to network and collaborate with each other and with others in the ID and HIV community.  In addition, we are offering a special limited time opportunity for Advanced Practice Providers who are not currently IDSA and HIVMA members to join the new community forum and the discussion as we evaluate additional strategies to enhance our support of Advanced Practice Providers. To join the forum through the end of 2018, please complete the registration form below. By registering for the forum, you will be able to participate in the new MyIDSA APP community but will not receive any additional member benefits. Please email us at info@hivma.org with questions.

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Degrees

Question Title

* 4. Organization

Question Title

* 5. Preferred email adddress

Question Title

* 6. What city do you practice in?

Question Title

* 7. What state do you practice in?

Question Title

* 8. What is your primary area of professional practice?

Question Title

* 9. How would you describe your primary employment affiliation?

T