Wufoo

HIV/AIDS Training Registration Form

American Red Cross, Greater Buffalo Chapter
786 Delaware Avenue, Buffalo, NY
Training Center (Located in rear of building)
For additional information, please contact:
Julie Rapp at (716) 878-2391
Monica Brown at (716) 878-2394

All trainings on this form are FREE

Please complete the registration form and click submit.

Name * First Last
Organization
Department
Title
Email
Phone * ### - ### - ####
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Please choose the training session you would like to attend: *
HIV Testing in NYS: 2005 Guidance; 7/12/07 (9 a.m. - 12:30 p.m.) HIV Testing: Skills Practive Ssssion; 7/13/07 (9 a.m. - 5 p.m.) Overview of HIV Infections and AIDS; (Niagara County) 7/31/07 (9 a.m. - 12:30 p.m.) HIV & STD's (Niagara County); 7/31/07 (1:30 p.m. - 5 p.m.) Mental Health Services: Ensuring Appropriate Referrals for HIV Positive Clients; 8/7 & 8/8 (9 a.m. - 5 p.m.) HIV/AIDS Confidentiality Law; 8/13/07 (1:30 - 5:30) What's New in HIV/AIDS; 9/17/07 (9 a.m. - 12:30 p.m.) HIV/AIDS Confidentiality Law; (Niagara County) 9/17/07 (1:30 p.m. - 5 p.m.) Tailoring HIV Counseling & Testing to Unique Needs of Adolescents; 10/2/07 (9 a.m. - 5 p.m.) Reducing the Risk and Harm of HIV; 10/16, 10/17 and 10/18/07 (9 a.m. - 5 p.m.) Building Bridges to Cultural Competency; 11/1/07 (9 a.m. - 5 p.m.) Basic Information about Domestic Violence; 11/27/07 (9 a.m. - 5 p.m.) Introduction to Case Management; 12/6/07 (9 a.m. - 5 p.m.) HIV/AIDS Treatment Update; 12/13/07 (9 a.m. - 12:30 p.m.) Promoting Adherence to HIV Treatment; 12/13/07 (1:30 p.m. - 5 p.m.) Reducing Perinatal HIV Transmission in the Prenatal, Maternity, and Newborn Settings; 12/19/07 (9 a.m. - 12:30 p.m.) HIV Disclosure: Deciding Who & When to Tell; 12/19/07 (1:30 - 5 p.m.)
Primary Occupation
Administrator COBRA CFW COBRA CM/CMT Community Educator/Outreach Worker Counselor/Therapist Law Enforcement Domestic Violence Provider Emergency Personnel HIV Test Counselor MR/MH Worker Nurse Nurse Practitioner/Physician's Assistant Physician Social Worker/Case Manager Teacher/Trainer Student Other
Primary Work Setting
AIDS Treatment Center Alcohol/Drug Treatment Program CBO/Community Agency Child Welfare Services/Foster Care Correctional Facility/Jail Educational Institution EMS/Police/Fire Family Planning/PCAP Health Center Health Department Hospital Mental Health Institution Non-Institutional Nursing Services Nursing Home/Adult Care Center Physician's Office/Lab Other
Ethnicity
Not Hispanic or Latino(a) Hispanic or Latino(a)
Gender
Female Male Transgender
Education Level
Less than 12 Years High School/GED College 1 College 2 College 3 College 4 Graduate Degree Post Graduate
Race
American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Pacific Islander Bi-Racial Caucasian Unknown
Number of Years in Current Occupation
0-1 2-4 5-7 More than 8
County Most Worked In:
Do Not Fill This Out