Barwon Month of Action: Registration Form
The Barwon Month of Action (27th October to 25th November 2017)
Email address
Organisation/Group name
Your answer
Contact person/s
Your answer
Contact phone
Your answer
Contact email
Your answer
Name of the event/activity
Your answer
Brief description of event/activity
Your answer
Date of event/activity
MM
/
DD
/
YYYY
Time of event/activity
Time
:
Location of event/activity
Your answer
Is your event/activity open to the public?
Is there a cost to take part?
Would you like your event/activity included on the Month of Action website?
Are you partnering with another organisation? If so who?
Your answer
Who will be involved in the event/activity and how many?
Your answer
What are you hoping to achieve with your event/activity? (Prevention, awareness, intervention, improved response)
Your answer
Please complete the captcha before submitting the form.
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