headspace Cairns Event / Info Session Request Form

headspace Cairns Event / Info Session Request Form
headspace Cairns receives lots of request and we will do our best to attend whenever possible. Please give at least three weeks notice for any event so we have enough time to prepare and secure adequate resources. You will be contacted soon after headspace has recived your request. If you wish to speak with a headspace staff member please phone 4041 3780.
Name of Organisation / Group / School *
Contact *

First NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Date headspace will be required *

MonthDayYear
Start Time

:HourMinutesAM/PM Option
Finish Time

:HourMinutesAM/PM Option
What topics or subject areas would you like covered in your presentation? What is the theme/name of your event?*
Group Size
Age Group / Year level
Type of involvement you would like from headspace (tick all boxes)
If 'Other' please provide a brief outline of what you would like:
Issues that may be relevant (tick all boxes)

Mental HealthMeet headspaceTips for a healthy headspaceAnxietyDepressionBody image and Eating disordersBullyingStressExam stressStudyingGrief and LossDrugs and AlcoholHow to help a friendOther
If other please provide a brief outline:
Anything else we need to know?
Please upload any relevant files here

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