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Stories of Power, Purpose and Perseverance
Submission Form
1.
Personal Information
First Name
Last Name
Pronouns
Age
State of Residence
Phone Number
Email
2.
Preferred Method of Contact
Email
Phone
3.
Social Media Handles
Instagram
Facebook
Other
4.
Will you be attending NMAC’s Biomedical Summit in Atlanta, GA on Apr 8 - Apr 12, 2025?
Yes
No
Unsure
5.
Will you be attending the USCHA Conference in Washington, DC on Sept 4- Sept 7, 2025
Yes
No
unsure
6.
Form of Desired Submission
Written Narrative & Photography
(
personal story, a poem, or a letter to your past or future self)
Performance & Film
(
spoken word, dance, monologues, music, or other creative expressions)
Both
7.
Unique Perspective(s)
Long-Term Survivor
Advocate
Practitioner/ Healthcare Professional
PLWH (Person Living with HIV)
Other (please specify)
8.
Additional information you would like to share:
Send me a copy of my responses via email
