Conference Registration Form The New York City Syphilis Advisory Group Presents: Using Technology for Syphilis Elimination, HIV Prevention, Health Promotion and Access to Care A one-day conference exploring the field of Internet-based health solutions Date: Wednesday, November 14, 2007 Breakfast and lunch provided Location: The Downtown Conference Center at Pace University* 157 William Street, Manhattan (NW corner of William & Ann Streets) Toll free: 877-DCC-MEET Click here for location, directions and parking information *Please be advised that the Downtown Conference Center is located on William Street, one block south of the Pace University main building. If you have questions or need assistance, contact Millicent Freeman at 212-788-4427 Conference agendas will be emailed to registered participants on October 29th and will also be available at the conference. All fields are required. Registrant First Name Last Name Title Organization Name Phone E-mail Are you a presenter?  Yes  No Do you currently conduct Internet-based prevention activities?  Yes  No Which type of organization are you with? Please select... NYC Department of Health NY State Department of Health NYC Community-based Organization NY State Community-based Organization Other State Community-based Organization Private Foundation Community Member Other Verification:   (Please Enter the characters you see)