HERE - Pacific AIDS Network

pacificaidsnetwork.org

HERE - Pacific AIDS Network

RED ROAD HIV/AIDS NETWORK

SKILLS BULIDING MEETING

OCTOBER 4-5, 2010

EXECUTIVE HOTEL & CONFERENCE

CENTRE, 7311 WESTMINISTER HIGHWAY,

RICHMOND, BC

REGISTRATION FORM

Please return by fax/email to:

Red Road HIV/AIDS Network Society

Suite 804-100 Park Royal South

West Vancouver BC V7T 1A2

Fax: 604-913-3352 Email: klouie@red-road.org

Name:_______________________________________________________________________________

Organization/Title:____________________________________________________________________

Mailing

Address:_____________________________________________________________________________

City:________________________________Province:_________________Postal Code:____________

Daytime telephone

(Include area code):__________________________________Fax:______________________________

Email:______________________________________________

Red Road Member? ____Yes ____No

1.) Please check one that applies to your affiliation with the Red Road:

____ Organization member (Full membership, Aboriginal HIV/AIDS Organizations or an

Aboriginal Organization

____ Associate member

____ Individual

____ Aboriginal People Living with HIV/AIDS


____ Elder

Please send me information on how to become a member of the Red Road ____Yes ____No

SPECIAL NEEDS:

____Wheelchair Access ____Sharps Disposal ____Vegetarian

Other, (please specify)_________________________________________________________________

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