The mission of the HIV Planning Group (HPG) is to plan for the delivery of HIV services to reduce the impact of HIV. To help us process your HPG membership application, please provide all the information requested. You may enter N/A (not applicable) where appropriate. If there is any part of the application you do not understand, please contact the HPG Support Staff of the HIV, STD, and Hepatitis Branch (HSHB) of Public Health Services at HPG.HHSA@sdcounty.ca.gov.

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* 1. Select the option that applies to you:

Personal Information (will remain confidential and will not be forwarded with the remainder of the application)

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* 2. Full Name:

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* 3. Pronouns:

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* 4. Birth Date (day/month/year)

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* 5. I am a person living with HIV/AIDS:
(Note: this information will only be available to the Membership Committee Chair and Support Staff)

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* 6. If "yes", as a member of the HPG, I am willing to self-identify as a person living with HIV/AIDS.

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