Name *

First Name

Last Name

I wish to use an alternative name while participating in the online workshop. If you choose not to use your own name, you will be provided with instructions on how to access the Zoom call under an alternative name. Your name and email address will be used by the Sexual Health Centre to organise the workshop, but will not be shared with anyone outside of our organisation. Please visit www.sexualhealthcentre.com/data-protection-policy for further information on our data protection policy.

I consent to the creative materials I produce during the workshop (e.g. poems, drawings, stories etc.) being used in the production of an ‘End HIV Stigma’ zine by the Sexual Health Centre. If you choose to attend the workshop under an alternative name, you can still consent to your creative materials (poems, drawings, etc.) being used in the zine but your own name will not be published.

I consent to the creative materials I produce during the workshop (e.g. poems, drawings, stories etc.) being used by a mural artist to inform the design of a public mural in Cork City. Your individual contributions may not appear verbatim on the mural, but will be used by the ‘End HIV Stigma’ mural artist to inform the research and development of the mural’s design.

I wish to hear from the Sexual Health Centre about the support services available to people living with HIV following the workshop.

To mark World AIDS Day this year, the Sexual Health Centre will host a public talk about ‘End HIV Stigma’. If you would be interested in speaking about your experiences at this public talk, please check this box.