This form will give us an idea of the story you’d like to tell.

Before we use your story, we’ll be in touch to talk more about it, and see how it will best fit in with our current campaigns.
Almost all methods of sharing your story will require us to use an image or a video.  We’re not always able to employ professional photographers, so it would be helpful if you could upload some photographs or video content, you can do this within this form.  If you have any problems please email membership@debra.org.uk. 

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* 1. What is your full name?

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* 2. What is your date of birth?
(This form is for people aged 18 and over.  If you are under 18 please email membership@debra.org.uk instead).

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* 3. Your contact details

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* 4. I am a person who:

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* 5. The EB type relevant to me is:

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* 6. What are the three or four key elements of your story that you’d like to tell?

(You can talk about whatever you’d like here. But other people have talked about things like:
  • Their diagnosis of EB
  • The medical support they have or haven’t received
  • The public attitudes they’ve faced towards EB
  • Their family history of EB, or lack of
  • The support they have received from DEBRA
  • What a typical day looks like for them, and the impact of their EB on daily tasks
  • The impact of EB on their relationships (family, friends, work)
  • Their greatest triumphs and challenges
  • Something they wish more people knew about EB
  • Something they’re proud of

Please try and keep this section to a few paragraphs, no more than around 700 words.  We'll follow up with you for your full story.

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* 7. How would you feel comfortable sharing your story?

(We will talk to you about where your story and images would be shared before we use them – this just gives us an initial idea).

  Yes, comfortable No, I wouldn't Maybe I don't know
Social media
DEBRA website
DEBRA podcast
National media (newspapers, posters, TV adverts)
Local media
DEBRA publications (leaflets, magazines)
DEBRA emails
Publications or websites of other charities and organisations that DEBRA trusts
Giving a talk (e.g. to a company or a DEBRA shop)

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* 8. Please upload any photographs or video content that you are happy to share here.  If you have any problems please email membership@debra.org.uk.

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