Hepatitis Testing Day Event Submission Form - May 2014

Events submitted will be listed on the Web site at our discretion. We reserve the right to not list events. Please allow at least 3 business days from date of submission for events to be posted.

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Fields marked with * are mandatory
Organization Information
*




  (Use xxx-xxx-xxxx format.)  

Contact Information
*
*
(Use xxx-xxx-xxxx format.)
*
HTD Event Information
*

*
*          *
            Please include start and end times.
          


*

*        *       *
                
Will Hepatitis B testing be provided?*


Will Hepatitis C testing be provided?*


If yes, will rapid Hepatitis C testing be provided?


Will Hepatitis A vaccination be provided?


Will Hepatitis B vaccination be provided?


Is testing available at no cost?




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Do you provide ongoing testing throughout the year?



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