May12th.org.au - Submit 'Light Up The Night' Australia information

Use this form to submit information about an Australian building or landmark you or your organisation has organised to light up as part of May12th International ME/CFS Awareness Day.

This information is published on May12th.org.au and its social media accounts.

If you have more than one building or landmark to let us know about, please make multiple form submissions. It is recommended to submit the information as soon as you have confirmed it, rather than in one batch.

To assist our volunteers, please complete as many fields as possible before submitting this form.

Building or landmark lighting up

Building or landmark name*

Date or dates lighting up*

Include the day, date, month, year, times, and any other information.

Colour(s) lighting up*

Building or landmark address*

0/100

State or territory of the building or landmark*

Other information you want to let us know about the building/landmark, lighting, or anything else.

0/100

Who did you contact to organise this building or landmark?

For example, the shire council name, contact person, email address...0/100

You are welcome to forward us a copy of the email confirmation from the building/landmark owner so that we have a record, and for future years. Our email is info@may12th.org.au

Organiser

We keep a record of, and sometimes publicly list or thank, the organisation or person who organised the building/landmark lighting. This is usually someone assisting an ME/CFS organisation as the organiser, or as a volunteer of theirs.

Was this building/landmark organised for or on behalf of an ME/CFS organisation?*

YesNo

If your answer is yes, what is their organisation name?

0/100

If your answer is yes, what is your role or connection to the organisation?

I am a volunteer or employee of the organisation and am acting on their behalfI am a member, supporter, or donor, and want them to receive the organiser name creditI have no connection, but want them to receive the organiser name credit

If your answer is no, please let us know whether you want your name publicly listed as organiser credit.

Yes, list my name in publicNo, do not mention my name at all

If you want your name listed and made public, please write your name here

0/100

Consent

Consent*

I acknowledge that the above information (excluding anything private) will be used and published by the team^ behind May12th.org.au, including on the website, social media, and shared or published anywhere else as appropriate. (^This includes ME/CFS and Lyme Association of WA, Inc., and ME/CFS Australia Ltd and those assisting).I acknowledge that the information I have supplied is correct, and that if there are any changes or updates I will submit a new form submission with the updated or new information.

Your contact information

This information will not be published and is for record keeping purposes only.

I am submitting this form:*

on behalf of an organisationas an individual

Your first name*

Your last name*

Your e-mail address*

example@example.com

Organisation name (if applicable)

Comments (if any)

0/100

Ready to submit

Thank you for taking the time to submit the above information.

Please click the Submit button below.