Ambassador Application

Ambassador Application

Board of Advisors, AcknowledgementsYou must accept all of these.

YES: I believe that an education campaign to significantly improve male health, longevity, and quality of life is needed.

I agree that society needs to address the health care problems of men and the unfortunate effects those problems have on their loved ones, their employers, and our health care infrastructure. the media should be encouraged to focus attention on problems which plague men and which, by extension, affect the women in their lives.

I understand that I am not obligated to participate in the day-to-day activities of Men's Health Network and that I am simply endorsing the need for men to reach out for assistance, and encouraging them to do so.

Please list me as an advisor to Men's Health Network.

First Name *

Last Name *

Email Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country *

Phone Number

Professional Credentials

Position and/or Title

Organization

Opportunities for Involvement (check all that apply):Public Policy development in your StateBe a spokesperson on men's health in your StateServe as a media representative for MHNAdvocate for Men's Health Week in your StateVolunteer for MHN at a health fair or screeningAdvocate for the creation of an Office of Men's HealthSubmit written works for publishing in the Men's Health Library

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