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Clinical and Nutrition Services

HIV/AIDS 500/501 Online Registration Form

Contact Us

850-595-6500 x1505
Mailing Address
Fairfield Service Center, 1295 West Fairfield Drive, Pensacola, Florida 32501

Florida Department of Health in Escambia County
HIV/AIDS Program Office
AIDS-500/501 Registration

In order to ensure that each participant is registered for the training and receives confirmation; please provide the following information for our records, and complete the online form below.

Training Class Scedule (84.2 KB; pdf)
HIV 500 Participant Agreement (278 KB; pdf)

For more information please call (850)595-6500, x 1503

HIV/AIDS 500/501 Training Class Online Registration Form

Fields marked with an asterisk (*) are required.

Requested Date for 500/501 Class*

Name of Participant*

Participant E-mail Address*

Participant Phone Number*

Testing Site and Agency Number

Testing Site Manager Name

Testing Agency Address

Testing Agency City and Zip Code

Testing Agency Telephone Number*

Explain why you need to take this training

Enter Confirmation Number