Name
*
First Name
Last Name
Email
*
example@example.com
Phone/Text
*
City
*
County
*
State
*
I recently tested positive for HIV--or--my HIV diagnosis was not recent, but I am struggling right now. I'd like to connect with someone else who is living with HIV.
*
Yes, I could would like to talk with someone as soon as possible.
Not urgent at this time, but I'm joining the network and look forward to meeting others.
I'd like someone from WE THE POSITIVE to contact me, for another reason.
I would like to be an HIV advocate!
YES! I want to participate in advocacy activities, plus, send me your emails and updates.
Not at this time, I'd rather just receive emails and updates.
Submit
Should be Empty: