Form 1 NIH OAR NIMH Virtual Workshop Registration form

OMB #0925-0740

Exp date 7/31/2022

NIH OAR & NIMH Virtual Workshop

Registration Form

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NIH OAR & NIMH Report Out Session for the HIV-Related Intersectional Stigma Research Advances and Opportunities Virtual Workshop

September 18, 2020 11:30 am – 2:30 pm ET

Virtual

Sponsored by the National Institute of Mental Health (NIMH)

Registration

To register for the workshop on September 18, 2020, please provide the information requested below. You will receive a confirmation e-mail from the Bizzell Group ([email protected]) following your submission of this completed online form.

There is no registration fee and no on-site registration.

Contact Information

• denotes required information

First Name •:

Last Name •:

Street Address:

Suite I Apt I Box City:

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Email address •:

Organization •:

Role •: (dropdown options are community, research, private sector, CBO/NGO, government, and other [with a text box])