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The HIV/AIDS Information
Outreach Project A service of the New York Academy of Medicine Library, providing information to HIV and AIDS-related, community-based organizations in the New York Area |
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The HIV/AIDS Information
Outreach Project A service of the New York Academy of Medicine Library, providing information to HIV and AIDS-related, community-based organizations in the New York Area |
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| Become a Member | |
| If your organization is a not-for-profit community-based organization dealing specifically in HIV/AIDS-related services in the New York metropolitan area, then you are elible for membership in the HIV/AIDS Information Outreach Project. Print out the form below, complete it, then fax it to (212) 423-0266 OR mail it to the HIV/AIDS Information Outreach Project, The New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029-5293. | |
| Community-Based Organization (CBO) Registration Form | |
Organization Name:______________________________________________________ Address: _______________________________________________________________
Phone: ____________________________ Fax: _________________________________ Contact Person(s): Please provide the names, phone numbers and e-mail addresses of all persons in the organization who may use this service. You may attach additional pages if necessary. name: _______________________ phone:________________ e-mail:___________________ name: _______________________ phone:________________ e-mail:___________________ name: _______________________ phone:________________ e-mail:___________________ Does your organization currently have a Web site? Yes___ No___ If yes, please provide the address below:
If not, are you interested in having the Outreach design and host a site for you? Yes___ No___ Please describe the services that your CBO provides to communities affected by
HIV and AIDS. ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ If you have questions or need more information please call the Outreach Project Coordinator at (212) 822-7323. |
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The HIV/AIDS Information
Outreach Project The New York Academy of Medicine Library | 1216 Fifth Avenue | New York, NY 10029-5293 Tel: (212) 822-7323 | Fax: (212) 423-0266 | email:hivinfo@mail.nyam.org |
