To register as a media contact

During MND Week (2-8 May) and through to Global Day on June 21 MND associations around the country will be working hard to raise awareness of the disease. We are looking for people willing to share their experiences of living with MND with the media. We are assisted this year by JMM Communicationswho will be handling the media for the campaign, liaising with speakers and organising stories and interviews etc.

Our objective is to help educate the media, governments and the wider public about the impact of MND on people's lives. In 2010 we are supporting the National Disability Insurance Scheme campaign and we are particularly interested in how such a scheme would assist people living with MND to access the services they need as soon as a need arises.

We are also interested in how support groups, research, the MND associations, technology and computers, families and carers, community services, MND clinics and so on assist people with MND and their families with their daily and long-term needs.

If you are interested in being involved with MND Week and/or Global Day please take a few moments to fill out this form:

First Name *

Last Name *

Email *

Phone

Mobile phone number

The suburb you live in *

State or Territory *

I would like to register as a media contact *

yes

Your age group: *

less than 39

40 to 50

51 to 60

Over 61

Please specify your connection to MND *

Tell us a little about yourself *

Tell us about your experience of living with MND (if applicable)

Tell us about the ways you are assisted with managing MND eg: support groups, the MND Association, the services involved in your care, technology, other significant people in your life etc (if applicable)

I hereby authorise MND Australia and JMM Communications to use the information provided above for media purposes *

Please type the characters you see below

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