New Challenges and Unmet Needs of People Aged 18-50 Living and Ageing with HIV/AIDS - Quality of Life and Preventive Healthcare for PLHIV

Application form

The conference will take place in Kyiv, Ukraine, from 3 to 6 May 2018. For more information about the conference, please see www.ageingwithhiv.com/.

The application deadline is 12 February 2018 (23:59 Central European Time). All applicants will be notified of the outcome within 2 weeks after the deadline.

Please note that this application form is composed of several pages. Make sure that you complete all pages. This form will take you approximately 20 minutes to complete.

For questions, please contact Mariana Vicente or Maria Dutarte at projects@eatg.org

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* 1. Full name as it appears on your passport

Last Name:

First Name:

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* 2. Current gender

Male

Female

Prefer not to answer

Other (please specify):

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* 3. Date of birth

Date:

Date

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* 4. Your contact details:

E-mail address:

Telephone number including country code

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* 5. Your full postal address:

Street, Nr

Postal code

Country

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* 6. Please tell us about your motivation for attending this conference

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* 7. Please tell us about your experience about the topic of the conference

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* 8. Are you a member of/or affiliated to any groups or organisations working within the HIV sector?

Yes

If yes, please specify:

New Challenges and Unmet Needs of People Aged 18-50 Living and Ageing with HIV/AIDS - Quality of Life and Preventive Healthcare for PLHIV

Application form

Question Title

* 1. Full name as it appears on your passport

Question Title

* 2. Current gender

Question Title

* 3. Date of birth

Question Title

* 4. Your contact details:

Question Title

* 5. Your full postal address:

Question Title

* 6. Please tell us about your motivation for attending this conference

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* 7. Please tell us about your experience about the topic of the conference

Question Title

* 8. Are you a member of/or affiliated to any groups or organisations working within the HIV sector?

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* 9. In your opinion what are the main challenges people aged 18-55 living with HIV/AIDS are facing?

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* 10. If accepted, how will you disseminate the conference information to a wider audience during and after the conference locally or internationally?