Please complete the below form if you wish to submit your story for us to use in our communications.

Media Consent Form

What will my story be used for? (Please tick the options you are happy with)
Can I remain anonymous? You can choose to have your real name published with your story or remain anonymous (in which case, we will use a false name). Please tick one of the following options:
I am happy to give my permission
Please tick this box to show you are happy to give permission for your story to be used by Alex TLC for the purposes outlined above.
Keep in touch
Unless you have already opted in to receive emails from us, we will only contact you about your request for our collection boxes. However, we would love the opportunity to keep you up to date about our work, events and other ways you can support us. Please let us know if you would like to receive our monthly News Round-Up by email

Data protection: The information that you provide here will only be used to contact you about sharing your story in our communications work. We will not pass the details recorded on this form on to any other organisation without your permission. we will store your data as per our Privacy policy which can be found on our website