Media and Press at the MEAStory / Photo Consent FormPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.The ME Association produces a range of communications resources to help raise awareness of ME/CFS, and provide support and information for people affected by the condition. We like to share the experiences of real people who are affected by ME/CFS and Long Covid in our communications as it helps to demonstrate the impact of the condition. By completing this form, you are providing The ME Association with permission to use your story or photos in our communications. Thank you for your help.Full Name *Email Address *We will keep this confidential as part of data protection, however as part of GDPR rules we need you to consent, and we will keep this contact email address on file in association with permission to use your story or photograph/s.PhoneAddressAddress Line 1Address Line 2CityCountyPostal Code— Select country —AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCĂ´te d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRĂ©unionSaint BarthĂ©lemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTĂĽrkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweĂ…land IslandsCountryI am over 18 *YesNoIf you are under 18, we need permission from a parent, guardian or responsible adult, and they will need to fill out the rest of this form:Parent/Guardian Full Name *Parent/Guardian Email Address *What will my story be used for? (Please tick the options you are happy with)Website: The ME Association's websiteSocial media: The ME Association's social media pages, such as Facebook, Instagram, X, LinkedIn, Threads, BlueskyPublications: The ME Association's leaflets, posters, newsletters, ME Essentials magazine, and other marketing materialsPrint and online media: National, regional and local papers; magazines and news sitesTelevision and radio: National and regional television; national, regional and local radioYou can choose to have your real name published with your story or remain anonymous (in which case, we will use a false name). Please select one of the following options:I am happy for my real name to be usedI do not want my real name to be usedAre there any identifying features you do NOT want included in our communications work? E.g. your locationPlease let us know if there are any ways in which you do NOT wish to be represented or described:If your story contains details or information about your diagnosis, do you give permission for us to share this information in the media story? *YesNoN/APhotograph permission (for images that you share with The ME Association, please tick where you are happy for those to be shared)Website: The ME Association's websiteSocial media: The ME Association's social media pages, such as Facebook, Instagram, X, LinkedIn, Threads, BlueskyPublications: The ME Association's leaflets, posters, newsletters, ME Essentials magazine, and other marketing materialsPrint and online media: National, regional and local papers; magazines and news sitesTelevision and radio: National and regional television; national, regional and local radioDoes your story or photos contain details (such as name/image) of other individuals? *YesNoIf so, please note that they will also need to complete a separate consent form to provide permission for their details to be shared.Have you previously submitted any of the attached photos to the Real ME Campaign?YesNoN/AIf so, are you happy to provide joint consent for the photo to be used for Media stories & Real ME?YesNo, just for Media StoriesNo, just for Real MEPlease read and agree to the following before submittingI understand that my details and photographs will be kept in a database.I understand that I can request photos to be removed from the database, however I understand that the previous use of the images may not be able to be removed. This is because images used on social media or websites can be saved or shared elsewhere, and once this happens we are unable to access it.I have read and understood the information above and I give permission for my story and/or images to be used by The ME Association for the purposes outlined above. *I agreeGDPR Agreement *I consent to having this website store my submitted information so they can respond to my inquiry.You may attach your photos here: Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.Send to The ME Association