Workshop - Tuesday 24 May 2022, Twizel Contact DetailsName* First Last Address* Street Address Address Line 2 City State / Province / Region Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Mobile Phone* Email* Enter Email Confirm Email Other Information We are asking for some information from you so we can make sure that we get a wide representation of people in your communities who are trained.Please select your age:*18-1920-2930-3940-4950-5960-6970-7980+Prefer not to sayPlease select your gender:*MaleFemaleNon-binaryPrefer not to sayPlease select your Ethnicity* NZ European Other European Māori Pasifika Filipino Other Asian (please specify below) Latin American (please specify below) Middle Eastern African Other (please specify below) Prefer not to say Ethnicity - please give more details how you would best describe yourself Employment Status* Full-time employment Part-time employment Student Retired Prefer not to say Other Name of Workplace / Organisation – please specify* Workshop 24th May 2022, Twizel Venue: Mackenzie Country Hotel, Cnr Ostler and Wairepo Roads, Twizel. Tel: 03 4350869 Date and Time: Tuesday 24 May 2022, 9.00am to 12 noon Training delivered by: Good Programmes TrustI confirm that I am 18 years of age or over* Yes No GoodYarn is a mental health education workshop designed to build people’s confidence and ability to talk about mental health. During the workshop wellbeing issues and suicide prevention issues are discussed. This can be difficult for some and we offer the following question for you to consider if now is the right time to attend a workshop.If you are unsure about the above requirements, please ring Michelle on 021 234 7413 or send an email to info@goodyarn.org before progressing further.Have you experienced serious personal or family trauma, or sudden loss, within the last 12 months?*If you have experienced any of these issues within the last 12 months one of our team will contact you to discuss before you attend the workshop. Yes No I'm not sure A light snack will be provided at the workshop. Do you have any special dietary requirements? Do you require any other special assistance?If you have any requirements for assistance please let us know how we can best support you (e.g. physical assistance or reading/writing)
