OPA+/ACAS Spring 2022 Gathering "HIV & COVID-19 Treatment Update 2022" Registration Form

Event: "HIV & COVID-19 Treatment Update 2022"

We invite you to this Spring 2022 OPA+/ACAS Support Program Joint Event!

Topic: HIV & COVID-19 Treatment Update

Speaker: Dr. Alice Tseng, UHN

Date/Time: Tuesday, May 17 2022 at 6pm to 8:30pm

Location: Bumpkins Restaurant, 21 Gloucester St, Toronto, ON M4Y 1L8

Dinner is included

TTC Tokens: Available upon request

If you have any questions, please email support@acas.org or ontariopa@gmail.com

We would like to thank ACAS, ASAAP, ViiV Healthcare and Bumpkins Restaurant for their generous support for OPA+.

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* 1. First and Last Name

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* 2. Email address:

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* 3. Phone number

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* 4. Are you already a member of Ontario Positive Asians (OPA+)? Note: OPA+ is an independent network for and by East, Southeast, South, West Asians/Middle Easterns and Indo-Caribbeans living with HIV/AIDS.

Yes

Unsure

If you are not already a member, please join OPA+ to attend the event. You can do so by indicating below by stating "I wish to join OPA+ as a member"

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* 5. What main course would you like to savour at the gathering? The choice is 1) Chicken Parmigiana or 2) Atlantic Salmon. A salad will precede, and dessert will follow the main course.

Chicken Parmigiana

Atlantic Salmon

If you have specific dietary needs, please note it here

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* 6. Are you registering an additional guest for the event? (Note: The additional guest must be a partner or caretaker).

Yes

If yes, please specify name and relationship (e.g. partner or caretaker)

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* 7. Are you registering an additional guest for the event? (Note: The additional guest must be a partner or caretaker).

Yes

If yes, please specify name and relationship (e.g. partner or caretaker)

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* 8. The session will be conducted in English, and we will strive our best to provide peer-based interpretation where possible. Do you require language interpretation support?

Yes

If yes, please specify language you wish to receive interpretation in:

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* 9. As a peer-based network, OPA+ can benefit from the skills and volunteerism of our members.

If needed, are you able to provide peer-based interpretation to another peer as a volunteer?

Yes

Not applicable

If yes, please specify language(s) you can provide language interpretation in:

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* 10. Do you have any accessibility concerns we should be aware of?

OPA+ will strive to do to our best of ability to provide support to meet your accommodation needs.

Yes

If yes, please specify:

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* 11. OPA+ operates under a tight operating budget and relies heavily on the financial donations and support of our sponsors. As such, we strive to minimize costs where we are able.

Recognizing that most Toronto residents now possess a Presto card, would you require TTC tokens to support your participation for this outing?

Yes

If yes, how many token(s) would you require? (Maximum 2 tokens per event)

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* 12. The following questions are optional, yet they provide valuable information about OPA+ members who attend our activities and may support us in gaining funding and sponsorship in the future.

What is your racial identity?

East Asian

Southeast Asian

South Asian

Middle Eastern/West Asian

Indo-Caribbean

Multi-racial

Do not wish to answer

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* 13. What is your gender?

Cis-man

Cis-woman

Non-binary

Trans-man

Trans-woman

Do not wish to answer

Other (please specify)

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* 14. What is your age group?

18 to 29

30 to 49

50 to 65

Over 65

Do not wish to answer

Thank you very much for registering for the OPA+ Spring 2022 Undetectable=Untransmittable Gathering!

As we value your input and wish to ensure our events provide value to our community, we will send out pre-event and post-event surveys to complete. We very much appreciate you completing the surveys as the results can support us in procuring future funding for events.

If you have any questions, please email: ontariopa@gmail.com

OPA+/ACAS Spring 2022 Gathering "HIV & COVID-19 Treatment Update 2022" Registration Form

Event: "HIV & COVID-19 Treatment Update 2022"

Question Title

* 1. First and Last Name

Question Title

* 2. Email address:

Question Title

* 3. Phone number

Question Title

* 4. Are you already a member of Ontario Positive Asians (OPA+)? Note: OPA+ is an independent network for and by East, Southeast, South, West Asians/Middle Easterns and Indo-Caribbeans living with HIV/AIDS.

Question Title

* 5. What main course would you like to savour at the gathering? The choice is 1) Chicken Parmigiana or 2) Atlantic Salmon. A salad will precede, and dessert will follow the main course.

Question Title

* 6. Are you registering an additional guest for the event? (Note: The additional guest must be a partner or caretaker).

Question Title

* 7. Are you registering an additional guest for the event? (Note: The additional guest must be a partner or caretaker).

Question Title

* 8. The session will be conducted in English, and we will strive our best to provide peer-based interpretation where possible. Do you require language interpretation support?

Question Title

* 9. As a peer-based network, OPA+ can benefit from the skills and volunteerism of our members. If needed, are you able to provide peer-based interpretation to another peer as a volunteer?

Question Title

* 10. Do you have any accessibility concerns we should be aware of? OPA+ will strive to do to our best of ability to provide support to meet your accommodation needs.

Question Title

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* 12. The following questions are optional, yet they provide valuable information about OPA+ members who attend our activities and may support us in gaining funding and sponsorship in the future.What is your racial identity?

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* 13. What is your gender?

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* 14. What is your age group?

* 9. As a peer-based network, OPA+ can benefit from the skills and volunteerism of our members.

If needed, are you able to provide peer-based interpretation to another peer as a volunteer?

* 10. Do you have any accessibility concerns we should be aware of?

OPA+ will strive to do to our best of ability to provide support to meet your accommodation needs.

* 12. The following questions are optional, yet they provide valuable information about OPA+ members who attend our activities and may support us in gaining funding and sponsorship in the future.

What is your racial identity?