What's Your Story Question Title * 1. Your name Question Title * 2. Which village/town do you live in? Aston Flamville Blaby Braunstone Town Cosby Countesthorpe Croft Elmesthorpe Enderby Glen Parva Glenfield Huncote Kilby Kirby Muxloe Leicester Forest East Leicester Forest West Lubbesthorpe Narborough Potters Marston Sapcote Sharnford Stoney Stanton Thurlaston Whetstone Wigston Parva Question Title * 3. Email Address Question Title * 4. Phone number Question Title * 5. Describe to us what activity, if any, you were doing before or what did you feel you needed to change? Question Title * 6. What made you change or made you realise you had to be more active? Question Title * 7. Describe to us what activity did you do and what did you have to change to enable you to do it and keep going? (Please also include the details of what other things changed other than your activity, eg. plans, help from friends,/family, changes with work etc.) Question Title * 8. Describe to us what outcomes have you seen, whether physical, mental, emotional and/or social and what your plans are longer term. By submitting this information, you agree for Active Blaby to use it for the purposes of promoting physical activity on their website.The details provided will be used as a story on our website. We promote activity wider than just our website but wouldn't use your details for this purpose without your permission. Question Title * 9. May we contact you at a later date to discuss further promotions? Yes No Question Title * 10. Would you like to an Active Blaby ambassador? (Click link below for more info on Active Blaby Ambassadors) Yes No Done
