Please fax or e-mail this form as follows:   
   
 Director:  Mrs Debbie Heustice  
 Centre for HIV and AIDS Networking (HIVAN)  
 HIV-911 Programme  
 Hut 10, Howard College Campus, University of KwaZulu-Natal, Durban 4001  
   
 Fax No:  086 518 7589  
 Email:  heusticed@hiv911.org.za