You can always press Enter⏎ to continue
Media Volunteer Form

Media Volunteer Form

If you have any questions when filling out this form, please email communications@bipolaruk.org
23Questions
  • 1

    Bipolar UK is often contacted by journalists from magazines, national newspapers, TV and radio asking if we can set up an interview with someone who’s living with bipolar, or with their families. It is useful for us to have a bank of people with lived experience who we can contact when media opportunities arise, or for our own campaigns.

    Before completing this form, please take some time to read through our Media Volunteer Pack

    Your details will be stored on our secure database. You can ask us to remove you at any point and we will delete your details straight away. We will only ever pass your details onto a publication or journalist if we have your specific consent at the time.

    You can read our Privacy Notice here.

    Please complete as much or as little of the form as you feel comfortable with. We ask questions about age and ethnicity so we can represent a range of people with bipolar in our communications.

    Press
    Enter
  • 2

    These first questions will be about you, your contact details and how you'd like us to communicate with you.

    Press
    Enter
  • 3
    Press
    Enter
  • 4
    Press
    Enter
  • 5
    Press
    Enter
  • 6
    Press
    Enter
  • 7
    Press
    Enter
  • 8
    -
    Pick a Date
    Press
    Enter
  • 9
    Please let us know your nearest town/city and county.
    Press
    Enter
  • 10
    Please Select
    • Please Select
    • Indian
    • Pakistani
    • Bangladeshi
    • Chinese
    • Any other Asian background
    • Caribbean
    • African
    • Any other Black, Black British, or Caribbean background
    • White and Black Caribbean
    • White and Black African
    • White and Asian
    • Any other Mixed or multiple ethnic background
    • English, Welsh, Scottish, Northern Irish or British
    • Irish
    • Gypsy or Irish Traveller
    • Roma
    • Any other White background
    • Arab
    • Any other ethnic group
    Press
    Enter
  • 11
    Please Select
    • Please Select
    • Male
    • Female
    • Non-binary
    • Other
    • Prefer not to say
    Press
    Enter
  • 12
    Please leave blank if you're not currently in work.
    Press
    Enter
  • 13

    The next set of questions will be about your experience with bipolar, whether you live with bipolar yourself or support a loved one.

    Press
    Enter
  • 14
    Press
    Enter
  • 15
    Press
    Enter
  • 16
    E.g. parent, spouse, friend, child.
    Press
    Enter
  • 17
    Press
    Enter
  • 18
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 19
    Press
    Enter
  • 20

    In this final section, we will ask about your preferences for volunteering with us, and about any topics you feel particularly keen to talk about.

    Press
    Enter
  • 21
    Press
    Enter
  • 22
    Press
    Enter
  • 23
    Press
    Enter
  • 24
    Press
    Enter
  • 25
    Press
    Enter
  • 26
    Press
    Enter
  • Should be Empty:
Question Label
1 of 26See AllGo Back
close