- All Participant Details Must Be Completed – - Select Relevant Cost Group – Select & Complete details for the Payment Option.

Details of Person Registering to attend:Title:   First Name:      Surname:     Organisation Name:    Postal Address:     Town:      Postcode:    Phone:      Email:     

I CONFIRM I/WE HAVE COMPLETED THE YMHFA FULL COURSE IN THE LAST 3 YEARS

YOUTH MHFA REFRESHER Monday 24th August 2020 Time: 0900-1300Venue: Latrobe Regional Hospital. Tutorial Rooms 2 & 3 Education Precinct, Monash Rural Health

Cost: External Organisation $85.00(+GST) Community Groups $25.00 (+GST)

*External example: Paid employee *Community example: sports groups, Volunteers

Free for LRH Staff Total Cost for    Participants = $      (+GST)

PAYMENT OPTIONS: (Must select the payment method & complete details)

Purchase Order #      Invoice to be sent to: Contact Name:       Email: Credit Card: Card Type:      

Card Number:      Card Expiry: MONTH / YEAR Name on Card:      Send Receipt to:      

Return Completed Registration Form to: educationtrainingunit@lrh.com.au Payments will not be processed until the course is completed. Cancellations with less than 7 days notice prior to commencement will incur full course cost, LRH staff will also be charged full

course cost if cancellations are made during this time.Note: The information provided in MHFA courses is for general mental health first aid only and is not intended to be and should not be relied upon as a substitute for specific professional medical advice.

Participants MUST have completed full course less than 3 years ago to attend. Refresher courses are 4-hour face-to-face courses that allow people who have previously completed a 12 or 14-hour Mental Health First Aid course to refresh their knowledge and skills. For people who are Accredited MHFAiders, the refresher courses offer an opportunity to extend their accreditation for a further 3 years.

The 4-hour refresher course allow people who have previously completed a Youth Mental Health First Aid course to refresh their knowledge and skills. The course also offers Accredited MHFAiders an opportunity to extend their accreditation for a further 3 years. Participants will gain an understanding of the latest research in the mental health field, learn the 3 key actions to help someone experiencing suicidal thoughts and behaviours, and work through complex mental health first aid interactions.

Course Registration Form 2020 - Page 2 - Additional Participants

Details of Additional Participants Registering to Attend:First Name:      Surname:     Phone:      Email:     

First Name:      Surname:     Phone:      Email:     

First Name:      Surname:     Phone:      Email:     

First Name:      Surname:     Phone:      Email:     

First Name:      Surname:     Phone:      Email:     

First Name:      Surname:     Phone:      Email:     

First Name:      Surname:     Phone:      Email:     

First Name:      Surname:     Phone:      Email:     

First Name:      Surname:     Phone:      Email:     

If registering multiple participants this page must be returned with completed page 1 of Registration Form to: educationtrainingunit@lrh.com.au

Payments will not be processed until the course is completed. Cancellations with less than 7 day’s notice prior to commencement will incur full course cost, LRH staff will also be charged

full course cost if cancellations are made during this time.Note: The information provided in MHFA courses is for general mental health first aid only and is not intended to be and should not be relied upon as a substitute for specific professional medical advice.