2023 HIV Prevention and Education Summit: Workshop Submission

Webinar Submission Form

• All of the following information must be completed in full.
• Do not email your webinar descriptions. It will not be accepted as a webinar submission.

Please Note: Webinars must be open to all people who attend the virtual conference; we cannot restrict attendance to any webinar.

If you are submitting for yourself, or submitting on behalf of a group that you are assisting/organizing, you will be identified as the primary contact for the workshop submission.

Please share all relevant information that you receive from CHTA to the speakers identified within the submission.

Below is all the information we will need from you.

Please provide full contact information for all speakers.

Please make sure any speakers that you submit have been contacted and notified prior to your submission. If you are the primary contact person and a speaker, input your data twice.

Please submit the following for all speakers

1. Full Name
2. Professional License if applicable (MD, PA, RN/CRNP, LSW, LCSW, CHES, AACO)
3. Organization
4. Primary Phone Number
5. Email Address (this is required)