APEC Volunteer submission form

APEC Volunteer submission form

Please note: you are not obliged to get involved with any of the meetings or events we may contact you about, this form is simply for our records and will not be shared with anyone else.
Name

First NameLast Name
In what way would you like to be involved with APEC?

Media/speaker volunteer listI want to submit my story for your websiteI am interested in helping with everythingResearch projects
Days I am available:

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Are you available at short notice? (Within 24 hours)

YesNo
Skills/areas of interest/strengths
Phone Number

Area CodePhone Number
I am interested in being involved with:

Study days - sharing my storyMedia - MagazinesMedia - TVMedia - local newspaperMedia - National newspaperPre-eclampsia researchOnline education discussion forum
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please tell us a little bit more information. Think about what happened to you, why you want to be involved and when you had pre-eclampsia/eclampsia or HELLP. If you would like to submit any files (story and photos) please use the upload features below.
Your Story

Cancelof
Image of yourself (headshot)

Cancelof
A family photo if you would like too (headshot)

Cancelof
I am happy to have my story and photos shared on the APEC website.

Story onlyStory and photosI do not want anything shared
If yes, are you happy for us to use your name?

YesNo
Thank you very much for getting in touch with APEC. We really appreciate your support.

As a result of this form submission we will contact you to discuss ways in which you could help us in the future regarding working with us and helping with our study days or awareness raising. We will email you first to arrange a convenient time.

If there is anything further you would like to know at this point please do not hesitate to contact Rowan study@apec.org.uk or Marcus mg@marcusgreen.org.uk

We hope to be in contact again soon and thank you.
Please select your role in the pre-eclampsia experience
Should be Empty: