TheBodyPRO Provider Network Question Title * 1. Contact Information Name Title/Primary Affiliation Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address Phone Number OK Question Title * 2. Profession/Avocation advocate business (health-related) health navigator lab technician journalist/writer medical student mental health professional nurse nurse practitioner peer educator pharmacist physician physician assistant prevention educator public health worker researcher student, health professions student, non-health professions Other (please specify) OK Question Title * 3. Affiliations Title Degree(s) Medical or Professional Specialty Membership in Organization(s) and Network(s) OK Question Title * 4. OPTIONAL: Please describe your race/ethnicity. OK Question Title * 5. OPTIONAL: Please describe your gender OK Question Title * 6. OPTIONAL: How do you describe your sexual orientation? OK Question Title * 7. OPTIONAL: Are you living with HIV? Yes No Prefer not to disclose OK Question Title * 8. Would you like to contribute to our content? Yes, I have a particular story/experience to share that I have written/recorded, or would like to write/record (give details below) Yes, I'd like to be interviewed on particular story/experience/topics (give details below) Yes, I'm a freelance writer or reporter who would be interested in ongoing assignments (give details below) No, but I have an idea for content you should put on the site/person you should interview, etc. (give details below) Details OK Question Title * 9. Are you interested in applying for membership in TheBodyPRO's Advisory Board? Members give input on our editorial and communications work, including upcoming projects and priorities, and share content of interest through social media, professional associations, and other opportunities. It requires 2-3 hours of effort per month, and members are added on a rolling basis to ensure good diverse representation by professional role, geography, race/ethnicity, gender, age, and other factors. At this time, membership is for providers based in the United States. Yes No Considering it; would like to discuss further OK Question Title * 10. What are your social platforms of choice? Facebook Instagram Pinterest Reddit RSS Feeds StumbleUpon Twitter YouTube I don't use social media Other (please specify) OK Question Title * 11. Would you like to subscribe to TheBodyPRO's newsletter (1-2 emails/week), which focuses on the HIV workforce? Click here to subscribe Not today Already get your email, but I'd also like to subscribe to TheBody's community newsletters so I'll click here. OK Question Title * 12. Anything else you'd like to share about your perceptions of, or interest in, TheBodyPRO as a resource for the HIV workforce? OK DONE