MAILING LIST OR CHANGE OF ADDRESS REQUEST - Close this window after you are finished to return to the Web site.
If you wish to be added or make an address change to the International AIDS Society-USA mailing list, which includes CME course program announcements and issues of our publication, Topics in HIV Medicine®, please complete this form. All information requested must be provided. Mail or fax the completed form to:

    International AIDS Society-USA
    425 California Street, Suite 1450
    San Francisco, CA 94104-2120
    (415) 544-9401 (fax)

Please check the appropriate box:

I am a new subscriber to the IAS-USA mail list
I am a current subscriber requesting a change of address
I am unsure of my status
First Name
MI
Last Name

IAS-USA ID Number
(if applicable - the number is located in the upper left corner of the IAS-USA mailing address label)

Degree or License (MD, RN, PA, none, etc)
 
Title/position

Institution/organization (no abbreviations please)

Specialty or primary field of interest

Currently, for how many HIV-infected patients are you providing care?

What percentage of your patients is HIV infected?

Mailing address   Home   Work

City
 State
 Zip
Country

Phone
   Home   Work
Fax
   Home   Work
E-mail

Do you work for a commercial company? (eg, pharmaceutical, diagnostic, medical product, advertising, insurance, investment, or communications)   Yes    No
If yes, name of company (you will be sent additional course/registration information)
Type of company

Source Code: WEB 08