Thank you for your interest in ACT’s online forum HIV and Aging with guest speaker Francisco Ibáñez-Carrasco, Ph.D.

This event is scheduled for Thursday, January 27, 2022 from 6-7 pm, plus additional time for questions.

Please complete the registration form below. We’ll need a name and email address so we can send you out a zoom link to attend the event. The zoom link won't be sent to you until the day of the Forum.

We are also asking some demographic questions – these questions help us keep track of who we are reaching and identify if there are folks that we are not connecting with. Demographic information is also important to our funders. Please answer these questions if you are comfortable, but know you don’t have to – as long as you provide us with an email address, we’ll send you a link to the forum.

For questions about this event, please email Aaron Clarke, ACT’s Gay Men’s Community Education and Resource Coordinator, aclarke@actoronto.org

Question Title

* 1. Please provide the contact information below:

Question Title

* 2. Of the categories listed below, which best describes your gender?

Question Title

* 3. How would you identify your sexual orientation?

Question Title

* 4. Of the choices below, which best describes your ethno-racial background?

Question Title

* 5. Do you identify as BIPOC (Black, Indigenous, Person of Colour)?

Question Title

* 6. What is your age group?        

Question Title

* 7. How did you hear about the event? (Please check as many as you wish.)

( Privacy & Cookie Notice

T