Request a Mobile HIV Test Van - AHF Netherlands - Request for your event

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Request A Mobile HIV Test Van For Your Event

Have an event and would like to have us come do some HIV testing at no charge with our mobile HIV test van? Just complete this form and we will respond to see if we can help!

AHF Ukraine's mobile HIV test van in action

    Your Information

    Agency’s Name*

    Contact Name*

    Contact Number*

    Name of Contact Person at Event

    Contact Number of Person at Event

    E-mail*

    Region*

    City*

    Address*

     

    About The Event

    Location of the Event*

    Name of Event*

    Date of Event*

    Detailed Summary of Event/Special Requests

    Estimate # of People Attending*

    Estimate # of HIV Tests*

    Will a parking space be reserved?

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    Ready to schedule a free test? Click to chat on WhatsApp!

    * Do not include sensitive information