Schedule for an Event
Interested in learning more about STI and HIV/AIDS prevention and treatment? Fill this form out and schedule a health or testing event today! You will not regret it!
Full Name
Mr.
Mrs.
Miss.
Prefix
First Name
Last Name
Contact Number
Please enter a valid phone number.
Email Address
example@example.com
Where will we host the event?
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What date and time work best for you?
Any other specific date and time, if the above selection is not suitable.
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Would you like for us to perform HIV testing?
Yes, please and thank you!
No, but thank you!
Have any suggestions or request? Enter them here!
We take all suggestions/request serious and will try to fulfill them (if possible), so please be mindful of what you put!
DISCLAIMER:
Our health and testing events usually last between 2-4 hours. If you wish to request a longer time period, please reach out to us beforehand at 601-329-2998 or ascoutreach103@gmail.com. If you are college/university that wishes to book an event for multiple dates, please reach out as well for scheduling!
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