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* 1. First name

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* 2. Last name

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* 3. E-mail

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* 4. Country

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* 5. State/territory

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* 6. In what year were you diagnosed? If you are not a person living with HIV, leave blank.

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* 7. My age is...

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* 8. My gender is:

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* 9. Are you a transgender person?

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* 10. Are you an intersex person?

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* 11. My sexuality is...

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* 12. Are you an Indigenous person?

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* 13. Do you speak a language other than English at home?

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* 14. My country of birth is...

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* 15. Have you worked for an HIV organisation in the past 5 years?

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* 16. Have you volunteered for an HIV organisation in the past 5 years?

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* 17. Have you been a client of an HIV organisation in the past 5 years?

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* 18. Do you have any accessibility requirements?

If you would like to apply for a participation bursary ($150) please complete the application form. Bursaries compensate for casual work hours missed due to participation in the event. You are eligible if you can provide a casual pay slip or a healthcare card.

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