Under 50s PLHIV Support Group Registration

Thanks for your interest in joining our group! If you have any questions, please contact paul.dugan@thorneharbour.org.

All responses are confidential.

First Name

Last Name

Email Address

Phone number

Are you living with HIV?

Yes No

Approximate Age Group:

Under 50 Over 50

How would you like us to contact you?

Phone Email

Does the time suit you?

Yes No Somewhat

Group meets 5.30–7pm on the second Tuesday of each month.

Comments

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