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Share your story

Thank you for taking the time to complete the Share your story survey. This survey has been compiled by Dementia Australia's Communication team to find out more about Dementia Advocates and what stories you have to share.

We would like to find out what topics related to dementia you would be interested in telling the world about. This could be anything from a passion for aged care reform to what hobby you have taken up since your diagnosis or becoming a carer.

After completing the survey the Dementia Australia Communications team will be in touch to find out more and to determine how best to tell your story. This could be on social media, in our eNews or more! 
1.What is your full name?(Required.)
2.What is your email?(Required.)
3.What is your phone number? (Required.)
4.I am:(Required.)
5.How would you describe the region you live in?(Required.)
6.Which of the following best describes where you live:(Required.)
7.What is your age?(Required.)
8.Are you:(Required.)
9.Are you of Aboriginal or Torres Strait Islander descent?(Required.)
10.Are you:(Required.)
11.Where you born in Australia?(Required.)
12.Do you speak a language/s other than English?(Required.)
13.What best describes your career, profession and significant skills?
14.What topics would you feel comfortable talking about? Please select as many as you like.(Required.)
15.Can you provide a brief summary of what you most want to share with the world about your story and dementia?
16.Do you celebrate/observe any special days that would be interested in sharing about (for example Valentine’s Day, Diwali, Father’s Day, Pride Month, World Hearing Day, National Gardening Week, R U OK? Day, Animal Appreciation Week, Lewy Body Dementia Awareness Week)
17.Is there anything on Dementia Australia social media and eNews that you would like to see that you are not already seeing?