Our next Referral Development Speed Networking event will take place from 12-2:30pm at the Health District Center, 1350 NW 14th St, Conference Room 401B, Miami, FL 33125. Lunch will be served at 12pm program begins at 12:45pm.

In order to improve our referral network, facilitate the implementation of a Status Neutral Approach which addresses our clients’ needs for holistic services and supports their engagement in HIV prevention and care, the Florida Department of Health and Ryan White Program are hosting a series of Speed Networking events for Case Managers, HIV Test Counselor and Outreach Workers in Miami-Dade. For these networking events to be successful we must have the right compliment of Case Managers/Service Providers and HIV Test Counselors/Outreach Workers.

Please fill out this questionnaire. Be aware that it is an application, not a registration. We will let you know if you are selected to attend at least a week before the event. If you are selected to attend, we are counting of your participation. Space is limited. We will be preparing a packet for each participant based on their responses, and we need to have an event number of participants to make this work.

Question Title

* 1. Name

Question Title

* 2. Pronouns

Question Title

* 3. Position

Question Title

* 4. Organizational Affiliation 

Question Title

* 5. Phone #  - best number to reach you

Question Title

* 6. Email 

Question Title

* 7. List all services provided by your agency 

Question Title

* 8. I can help with (list only services you provide or are able to facilitate for clients) 

T