malehealth.org.au · web viewplease complete the form electronically in microsoft word and email as...

Men’s Shed Spanner Registration Form

Please complete the form electronically in Microsoft Word and email as an

attachment to amsa@mensshed.net Enquiries to AMSA – 1300 550 009 or amsa@mensshed.net

‘Spanner in the Works?’ – Registration FormAbout Your ShedName of Shed

Physical address

Postal Address(Inc. Postcode & State)Contact person for this projectContact person phoneContact person email

2nd Contact person2nd Contact person phone2nd Contact person email

About your eventProposed date and time?(agreed with Health Service)

No of Booklets requestedOther information?(Guest speakers etc)

About your Health Service PartnerName of Health ServiceContact nameContact phoneContact emailThe Department of Veterans' Affairs Men’s Health Peer Education programme may be able to assist and support your ‘Spanner in the Works?’ programme with information stands and health talks.If interested, contact the DVA MHPE Coordinator for your State/Territory www.dva.gov.au/mhpe.htm or phone 133 254.