HVTN/CoVPN Speaker Request Form

Please answer the questions below so that we can identify a potential speaker for your event.

Please provide as much information as possible so we can identify the right speaker for you.

Please note: Speaker requests should be submitted at least 2 weeks before the projected event date. Requests submitted within 2 weeks of the event date may not be fulfilled.

Speakers are to be utilized for the purpose of providing scientific education surrounding HIV, COVID-19, and related topics. Speakers are not to be requested for the purpose of personal consultation. Speakers may not be representatives of the HIV Vaccine Trials Network or COVID-19 Prevention Network and may not speak on behalf of the Networks, unless appropriate.

Event Organizer Information

First Name *This question is required.

Last Name *This question is required.

Title

Organizational Affiliation

City

State

Zip

Country

Email Address *This question is required. This question requires a valid email address.

Phone Number *This question is required.