After completing this form, please allow 3-5 business days to receive a confirmation from Zoom with an access link and more information.

With registration students will also receive a complimentary annual membership with the American Academy of HIV Medicine, granting access to educational opportunities, publications including a biweekly Clinical Research Update and a quarterly HIV Specialist Magazine, and you will join with a global network of HIV care providers.

Question Title

* 1. Name

Question Title

* 2. Race (select all that apply)

Question Title

* 3. Ethnicity

Question Title

* 4. Country of birth

Question Title

* 5. Personal email address 

Question Title

* 6. Phone number

Question Title

* 7. Mailing address (will be used to deliver AAHIVM's free quarterly HIV Specialist magazine)

Question Title

* 8. What is the name of your school or training program? (ie Keck School of Medicine at USC)

Question Title

* 9. In which state, territory, or region is your school or training program?

Question Title

* 10. What is your current field of study? (select all that apply)

Question Title

* 11. When are you due to graduate from your school or training program?

Question Title

* 12. Where could you see yourself working after graduation? (select all that apply)

Question Title

* 13. Please rank your preferences for which breakout session you would like to attend. Breakout session assignments are made on a first-come first-serve basis. A recording of all breakout sessions will be made available after the Student Open.

Question Title

* 14. I am likely to make HIV prevention and care or research a central part of my career.

Question Title

* 15. What skills do you expect to learn from the Student Open?

Question Title

* 16. How would you describe your current level of interest in HIV, hepatitis and emerging infectious disease work or research?

Question Title

* 17. Would you like to receive curated information on student or trainee opportunities in HIV, hepatitis and emerging infectious disease research?

Question Title

* 18. Would you like your name included in a raffle drawing to win a copy of AAHIVM's Fundamentals of HIV Medicine textbook?

Question Title

* 19. At the Student Open, during the break, a video will feature  the insignia of participants' schools and training programs. If you would like your school or institution's logo or insignia to be included, please upload that file here.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
0 of 19 answered
 

T