Childrens Liver Disease Foundation

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Events Questionnaire

Publicity can be a great way to help you raise even more funds and vital awareness of the Children's Liver Disease Foundation. The CLDF Communications Officer will be pleased to help. In order to do so, we need your help first by completing the following form. Please give us as much information as possible about the following.
Thank you.

Personal Details

* Name:

d: / m: / y:

* Date of Birth:

* Address:

* Event:

d: / m: / y:

* Date of Event:

* Telephone Number (day):

Telephone Number (eve):

Mobile Number:

* Email:

1. Why did you choose to support CLDF?

2. What made you decide to do this event?

3. Please give a brief outline of any preparation, if relevant, that you have made for this event.

4. What are the main regional newspapers in your area? What are the main radio stations and what are your two regional news programmes on BBC 1 and ITV?

5. In which type of media would you be willing to participate in order to raise awareness of the fact that you are taking part in this event? Please tick

Local Papers

National Papers

Medical Publications

Consumer Magazines (e.g. Woman, Men's Health, Bella)

Television

Radio

6. This box has been left blank for you to put in any other information you feel may be relevant.

Data Protection Act
The information given to us in this form will only be used in relation to CLDF publicity work.

Please note that all press releases will appear on the CLDF website for approximately 4 weeks.

Please tick here if you do not wish your press release to be placed on the site

Thank you for taking the time to fill in this form.