HVTN Full Group Meeting
Washington, DC | May 30 - Jun 1, 2012
Breakout Session Request Form

Deadline: April 13, 2012

Please note that meeting request forms will be processed on a first come, first serve basis. The date we receive your request will help determine the size and quality of your meeting room.

Meeting Chair:
Requestor (if different from Meeting Chair):
Contact Phone:
Contact E-mail:
Name of Breakout Session:
Please list a brief description of breakout session objectives:
Please order the dates by preference:
(1 first choice, 2 second choice, etc.)		 Wednesday, May 30
Thursday, May 31
Friday, Jun 1
No Preference
Other Date:  
Duration of meeting:
Order the room set-ups by preference:
(1 first choice, 2 second choice, etc.)		 U-Shaped
Boardroom
Hollow square
Classroom
Round tables
Theater seating
No Preference
Other:
Please check/list any equipment necessary for your session: Laptop computer (need to borrow from conference)
LCD projector and screen
Microphone
Flip chart
Conference phone
Other equipment:
Interpretation:
Interpretation requests must be received by April 13, 2012.
We will do our best to accommodate requests; however, if there
is not sufficient demand, this service may be canceled. 		Spanish

 
Is this session open or closed? Open to anyone interested
Closed - for committee members or invitees only
Expected Participants:
 Please write down what groups are expected, i.e. CAB Members,
CER Members, Laboratory, etc. Please be as specific as possible i.e. Clinic Coordinators involved in 505 Protocol.
Number of Expected Participants:
Please write down groups if any that conflict, i.e.
CAB Members, CER Members, Laboratory, etc.:
Comments and/or special requests: