Request edit access
US PLHIV Caucus Membership Form


The United States People Living with HIV Caucus (or the HIV Caucus) is a group of organizations, coalitions, networks, client groups and individuals with HIV who advocate for people with HIV (PLHIV) in the U.S. Formed in January 2011, the HIV Caucus includes diverse and accountable representation by people living with HIV from throughout the United States.

The HIV Caucus believes in and is predicated upon the principles of self-empowerment and self-determination, as embodied in the Denver Principles and GIPA/MIPA principles (Greater Involvement of People with HIV/AIDS and Meaningful Involvement of People with HIV/AIDS).


Membership to the U.S. PLHIV Caucus is open and free to every person living with HIV/AIDS. To become a member, please complete the form below. Respecting confidentiality you need only provide what information you are comfortable sharing, if you want to stay connected, we will need email and phone contact information from you. If you are not comfortable sharing that information you can follow us on facebook or at: www.hivcaucus.org.


Email address *
Full name ( First then last) *
Preferred name (if applicable)
Address (optional)
City *
State *
Zip code *
Phone number *
Preferred way for us to contact you *
Gender *
Sexual orientation *
Race *
Age Range *
Groups or organizations you are you are affiliated with.
As a member of the US PLHIV Caucus you are asked to join one of the work groups. Please indicate which group(s) you would like to participate in. *
Required
Year diagnosed with HIV *
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. - Terms of Service