Events Promotion Program Application
Please complete the application form below and complete your promotion package before submitting.
Organization:
Contact Person:
Street Address:
City:
State:
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code:
Phone Number:
Email Address:
Non Profit:
Yes
No
Name of Program:
Program Website:
Program Description:
Date of Program:
Please enter a date between 3/20/2026 and 12/31/2027
Location of Program:
Venue, City, State and/or Country
Program Directors:
Program Type:
New Program
Established Program
Total MOC Credits:
Maintenance of Certification
Total CME Credits:
Continuing Medical Education
Target Audience (select all that apply):
Clinicians
Fellows
Residents
Specialist
Students
Other
Target audience must be in or interested in the field of infectious diseases and/or HIV.
Specify:
Estimated Number of Attendees:
Level of Program:
Basic
Intermediate
Advanced
Geographic Representation:
Regional
National
International
Please Select Package:
Premiere Level - $7,500 per event
Special Offer - $4,000 per event
Alliance Level - $1,500 per event
Value Level - $600 per event
Additional Comments:
Contact Information