Register to share your stories with media

MND Week 2012 will be held 6-12 May 2012, and MND associations around Australia will be working hard to raise awareness of MND. But we need your help.

We are looking for people living with MND, or their families, who would be willing to share their stories through the media.

This year we are highlighting the active minds of people in the MND community and how their spirit keeps us fighting MND. Perhaps you are working, studying, fundraising or raising a family? Whatever it is – large or small – we’d like hear your story.

We often get calls from local papers and radio stations wanting to interview a person in their area, and we need to be prepared with a list of willing contributors/ambassadors.

If you are interested in being involved with MND Week and/or Global Day in June, please take a few moments to fill in this form. Find out all the ways you can get involved in MND Week here.

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
no

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 how you keep your mind active and/or what you've achieved since your diagnosis of MND

Tell us about your experience of living with MND and/or about how a National Disability Insurance Scheme (NDIS) would improve the quality of life of people living with MND

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

yes
no

Please type the characters you see below

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Register to share your stories with media

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