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

Registration is required at least one week in advance of all schedule classes and updates.

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