Testing & Outreach Request Form

If you are looking for tabling or testing in the Hampton Roads area, please fill out the form below.

Please note that we require 4 weeks notice to accommodate external testing events.

Fill out the form below to request testing at your event!

Preferred or Given Name *

First

Last

Pronouns

Name of Organization

E-mail *

Phone *

Name of Event *

What type of support are you looking for from the LGBT Life Center? *

Information & Resources - We'll set up a resource and information table to talk about our services and our organization
Mobile Testing Outdoor - We'll bring our mobile testing van
On-Site Testing Indoor - We'll come and perform rapid HIV testing (Indoor Space with a door required)
Outreach - We'll provide condoms and education about PrEP, as well as linking eligible individuals with PrEP

Please select all that apply. We will be in touch.

Address of Event *

Address Line 1

Address Line 2

City

State

Zip Code

When is your event? *

Please note that we require no less than 4 weeks notice for outreach events

What time is your event? *

Please include your start time, including set-up time, and your end time.

Please briefly describe your event. *

Please upload any visuals and/or marketing materials that have been generated for your event. *

Click or drag files to this area to upload. You can upload up to 2 files.