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What's Your Story

1.Your name(Required.)
2.Which village/town do you live in?(Required.)
3.Email Address(Required.)
4.Phone number
5.Describe to us what activity, if any, you were doing before or what did you feel you needed to change?
6.What made you change or made you realise you had to be more active?
7.Describe to us what activity did you do and what did you have to change to enable you to do it and keep going? (Please also include the details of what other things changed other than your activity, eg. plans, help from friends,/family, changes with work etc.)
8.Describe to us what outcomes have you seen, whether physical, mental, emotional and/or social and what your plans are longer term.
By submitting this information, you agree for Active Blaby to use it for the purposes of promoting physical activity on their website.

The details provided will be used as a story on our website. We promote activity wider than just our website but wouldn't use your details for this purpose without your permission.
9.May we contact you at a later date to discuss further promotions?
10.Would you like to an Active Blaby ambassador? (Click link below for more info on Active Blaby Ambassadors)