Tabling Testing Request - Be You Colorado

Today's Date *

MM/DD/YY

Requester Name

First Name

Last Name

Requester Email

Requester Phone Number

(999) 999-9999

Event Information

Event Name

Organization Name

Date of Event

Set-up Time

Start Time

Stop Time

Event Address

City

State

Zipcode

Is street or lot parking available?

Yes

No

If no, will organizer pay for parking?

Yes

No

Will tables and/or chairs be provided?

Yes

No

If yes, how many chairs and/or tables will be provided?

Safer Sex Supplies

Be You Colorado offers safer sex materials and demonstrations during our tabling including insertive and external condoms, personal lubricants, and sex-positive materials on safer sex.

Are there any materials we are prohibited from bringing for participants?

Prohibited materials

Testing

Be You Colorado can provide free rapid STI testing (HIV, Hepatitis C (HCV), Syphilis, Gonorrhea, and Chlamydia) for participants ages 24 and under.

Do you want STI testing to be provided at the event?

Yes

No

If yes, please indicate which testing you would like provided:

HIV

Hepatitis C (HCV)

Syphilis

Chlamydia/Gonorrhea

Note: Chlamydia/Gonorrhea testing only available in Denver metro area.

Testing requires a quiet, private space with a table and two chairs where a 20-minute confidential testing session can
be conducted with a participant.

Will the tester have access to a private space on site to conduct testing?

Yes

No

Will participants have access to a bathroom for Chlamydia/Gonorrhea testing?

Yes

No

N/A

Please indicate what will be available in the testing space:

Table or other non-porous, stable surface

Two chairs

Trash bin (for non-biohazard trash)

Privacy dividers

Any additional information about the event?

Captcha

TABLING & TESTING REQUEST FORM