Advisory Board Application

Board of Advisors, Acknowledgements *

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 *

Professional Credentials

Position and/or Title

Organization

Email Address *

Home Phone

Work Phone

Mobile Phone

Address 1 *

Address 2

City *

State *

Zip Code *

Country *

Opportunities for Involvment (check all that apply):

Public Policy development in your state

Be a spokeperson on men's health in your area

Serve as a media representative for MHN

Advocate for Men's Health Week in your state

Volunteer for MHN at a health fair or screening

Advocate for the creation of an Office of Men's Health

Submit written works for publishing in the web-based Men's Health Library

Other, please include your ideas

Opportunities for Involvment (check all that apply): Other, please include your ideas

Published Writing or other works

Files must be less than 2 MB.
Allowed file types: gif jpg png pdf doc docx ppt pptx.

Resume or CV

Files must be less than 2 MB.
Allowed file types: pdf doc docx ppt pptx.

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