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Email *
First Name *
Last Name *
Agency of Employment *
Cell Phone Number *
Office Phone Number
City / Zip *
Credentials *
Supervisor Name *
Supervisor Phone Number *
Supervisor email *
Do you need . . .
I am new to this project - not sure what training I need. *
Required
INSTI Rapid HIV Testing & Prevention Counseling Training? *
Required
Serum-based HCV Testing Training? (Ideal for sites where labs are routinely drawn on admission) *
Required
Rapid HCV Testing Training? (Note: preliminary positives must be confirmed via blood drawn specimen) *
Required
Help with HIV Positive report forms? *
Required
Help with Imagine Hope Quarterly Report: Tell us your story *
Required
Help with HCV Monthly Recap? *
Required
Help with HCV Quarterly? *
Required
To learn faster, easier way to report HCV positives *
Required
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