Request "The Power of Peers" video in Windows Media Player format

The video, The Power of Peers to Change Lives, can be made available to organizations who would like to use it in presentations or to view on their computers. To request a copy of the .wmv file which can be played using Windows Media Player, please fill out this form:

Name: *

Organization: *

City/Town: *

State: *

How would you describe your organization?:

Community-based organization

Hospital

Health clinic

AIDS service organization

Social Service Agency

Other

If other, please describe:

Does your organization receive Ryan White funding?: *

Yes

No

Don’t know

If yes, what part(s)? (Check all that apply.):

Part A

Part B

Part C

Part D

How do you plan to use this video?: *

Would you like to be added to our mailing list to receive PEER Center updates via email?:

Yes

No

Email address: