Walk with M.E. share your story

How we store and share your story

Please choose yes or no in each box below as appropriate, and then complete section two (and three, if appropriate) below to give your contact details and consent.

Question Title

* 1. I give consent for Action for M.E. to hold the sensitive personal data I share about myself, in accordance with its privacy policy.

Yes

No

Question Title

* 2. I give consent for Action for M.E. to include my story and image in its members’ magazine, InterAction and/or on its website and/or social media for the purpose of:
· raising awareness and understanding about M.E. and its impact
· fundraising to ensure that Action for M.E. can reach even more people affected by M.E.

Yes

No

Question Title

* 3. I give consent for Action for M.E. to send a press release featuring key details from our story (including names, ages and general location, but not full address, email or contact number) and an image of me to journalists. I understand that Action for M.E. will contact me on for permission on each occasion before giving out my contact details to any journalists.

Yes

No

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* 4. I understand that, if I am under 18, my parent or guardian must also give their consent for Action for M.E. to store and share my story by completing section three below.

Yes

No

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* 5. Your contact details and consent

Name

Signature

Email Address

Today's date

Question Title

* 6. Your parent's contact details and consent (if under 18)

Name

Signature

Email Address

Today's date