Request the Video: Hope Against HIV: Microbicide Trials in Your

Many thanks for requesting the educational video, Hope Against HIV: Microbicide Trials in Your Community. Groups or individuals located in developing countries will be sent one complimentary copy of the DVD. For those located in industrialized countries, we will kindly request a nominal donation of $5 to cover the costs of producing and shipping the video to you. We will review your request, and contact you with confirmation and further details by email within five business days. You should receive your DVD within two to four weeks. Questions? Please write to microbicidevideo@ipmglobal.org.

Video Format *

PAL

NTSC

Which format is right for me? NTSC formatted DVDs are used in most of North America (including the US), South America, Japan, South Korea, Taiwan, Burma and some Pacific Island nations and territories. PAL formatted DVDs are used in most other countries, including most of Africa and Europe. If you are not sure which format to select, find out more here: PAL: http://en.wikipedia.org/wiki/PAL or NTSC: http://en.wikipedia.org/wiki/NTSC

Your first name *

Your last name *

Your email address *

Organization name

IPM research center partners

Yes, I am ordering for an IPM clinical research center partner

No, I am not ordering for an IPM clinical research center partner

Address *

Apartment or Suite #

City *

State

ZIP/Postal Code *

Country *

Telephone

Language(s) you will use in your community *

Each DVD contains the video in 5 languages. Which language(s) you plan to use in your community?

Use of video *

Please tell us how your organization plans to use the video.

Request the Video: Hope Against HIV: Microbicide Trials in Your Community