Your story, your consent

Thank you for sharing your story with the PHA UK. Please complete the short form below to confirm you are happy for your words and experiences to be published. If you have any questions, or you’d like to withdraw your consent at any time, please email media@phauk.org or call 01709 761450.

Permission to share my story

Your name(Required)

Are you happy for your name to appear with your story?(Required)

Yes, that’s fine

No, I would like my name changing

Please confirm you are happy for your story, or parts of it, to be shared in the following ways (mark all that apply):(Required)

On one or all of the PHA UK websites

In printed materials published by the PHA UK, including Emphasis

On the PHA UK social media channels

As part of press / media releases to raise awareness of PH

In presentations / at events organised or attended by the PHA UK

If you have submitted photos to be used with your story, please check this box to confirm you are happy for these to be used in the ways identified above

I’m happy

Please add comments if you wish

Please enter today's date as confirmation of all of the above(Required)