Share Experiences (aged under 18)

I am aged under 18 and want to share my experiences.

We're pleased you want to share your experiences; we just need consent from your parent(s) / guardian before we can put you in touch with other young adults from the 18-25 Network, or before we can sign you up for any of the options below. We'll contact your parent(s) / guardian with a copy of this form once you have submitted it to us, along with a parental consent form for them to complete and return to us.

Please give their contact details:

Parent / Guardian's name:*

Parent / Guardian's email:*

Parent / Guardian's phone number:

Your first name:*

Your surname:*

Please select one:*

How old are you?*

The Type of SMA that affects you / the person who has SMA:*

I am interested in (tick as many as apply):

Being in touch with young adults from the SMA UK 18-25 Network

Joining the Ask a Question Network

Talking to people at Information, Support & Social Events

Talking to politicians and decision makers

Talking to the media

Writing for SMA Voices

Sharing my tips / experiences / photos for the Living With SMA website section

(Optional) In particular, I would like to share my experiences of:

You can contact me at:

Email:

Home phone / mobile:

How did you hear about Sharing Experiences?

I consent to SMA UK safely storing and using this contact information so that you can respond to my request. SMA UK will not share my information with any third party unless I give permission or they are required to do so by law. I know I can read more about this in the Privacy Policy

Support

Share Experiences (aged under 18)

I am interested in (tick as many as apply):

You can contact me at:

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