Share your story with us



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Share your story with us
Too often the voices of older people in London are not heard and we want to change that. We know that getting older affects us all differently so we want to hear from you about your individual experiences of growing older in the capital.
By sharing your story with us we can help to get your views and experiences into the media, raising awareness and getting the issues that matter into the wider debate. We want to hear from you whether you have had positive or negative experiences as everyone’s story is important and can help us to show what is working, what isn’t and what needs to change.
To share your story


  1. Simply fill in this form and return it, freepost, to:

Share your story

Age UK London

FREEPOST LON 7615

SE1 6BR



  1. We will give you a call back to talk you through how you can share your story and what this involves.




  1. When the media requests come in we will call you and discuss whether you would like to participate (we will never expect you to speak to the media if you are not comfortable doing so and will not will not share any of the information you have given us, or your contact details, without your express permission.)

If you think you would like to share your story but you have any further questions you can fill out the first page of the form only and we will call you back to discuss further.


We look forward to hearing from you.
Yours sincerely,

Age UK London


Fill in this form to share your story with Age UK London

By providing this information you are agreeing to Age UK London contacting you to discuss sharing your story with the media.
PART ONE: Your information
Title Mr/Mrs/Ms/Miss/Other: (delete as appropriate)

First names Surname

Address

Postcode

Home telephone

Mobile telephone

Work telephone

Email address

Date of birth (dd/mm/yyyy)

Male/Female/Transgender (delete as appropriate)

Journalists may sometimes ask for a representative from a particular racial or faith group or sexuality which is why we are collecting the information below. If you do not want to share this for any reason please do not feel that you have to.


How would you describe your ethnicity?

 White  Mixed background

 Asian or Asian British  Black or Black British.

 Chinese  Any other (please write in)


Are you a member of a religion?

 Christian  Jewish  Sikh

 Muslim  Buddhist  Hindu

 None  Any other (please write in)


How would you describe your sexuality?

 Heterosexual  Gay/Lesbian  Bisexual



PART TWO: Your story

Age UK London is the London regional voice of independent Age Concerns/Age UKs across the capital. If you choose to tell us your story below, you are consenting to a confidential record of this information being stored by Age UK London on paper and computer. We take great care to safeguard this information, but we may on occasion share it with other organisations in the Age UK family for the purposes of media work, campaigning and/or events support. Your information will never be passed to any external agency or organization without your consent. We reserve the right to hold this data for a period of five years after which time we agree to contact you again to ensure you are happy to remain on our databases and to update any changes in your circumstances.

If you would like to share your story but would prefer to provide your details over the phone rather than filling in this form, leave the rest of the form blank and we will call you.
NB. There are additional pages at the back of this form if you run out of space.
Questions
1. Do you have a story to tell about any of the issues listed below? If so please tick any boxes that are relevant and explain how or why these issues affect you in the space underneath.
 Money worries (including pensions, state benefits, etc.)







 Using care services, emergency services and/or the NHS







 Access to lifelong learning and adult education











 Getting around, access and transport issues









 Age discrimination











 Getting a decent, nutritional diet (including eating properly in hospital)











 Getting enough exercise and/or being physically active










 Health issues and/or managing a long-term condition










 Being listened to











 Career challenges











 Accessing local services and/or getting a decent service from companies you use









 Feeling safe in your area











 Feeling alone, not getting out enough and/or not seeing enough of family or friends









 Housing worries and/or unsuitable living arrangements













 Other: (insert here)





2. What is the best thing about getting older?







3. What is the worst thing about getting older?









4. What is the one thing you would most like to stand up and shout about?







PART THREE: How you would like to help

1. Would you be happy to tell your story in London Age (Age UK London’s magazine)?

Yes  no  more info please 

2. Would you be happy to tell your story on Age UK London’s website?
Yes  no  more info please 

3. Would you be happy to talk on the radio or on TV?
Yes  no  more info please 

4. Would you be happy to have your photo taken and used in a magazine or online?
Yes  no  more info please 

5. Would you like to be involved in our campaigning and influencing work?
Yes  no  more info please 

6. Would you like to speak at events about the issues that affect you?
Yes  no  more info please 
At Age UK London we like to keep you informed about our work and opportunities to support us. If you are happy to be contacted by us, please tick this box 


Thanks so much for sharing your story with us, we will be

in touch with you soon.

Additional pages (please make it clear which question you are continuing from)























































































































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