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The (B)OLDER Project

Thank you for your interest in the (B)OLDER project. I am delighted you would like to take part. Please apply by filling out this release form.

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Question 1 of 5

What is your first name and age?

Question 2 of 5

Your email address (we will use this to keep you up to date with The Midlife Movement, including the (B)OLDER Project)

Question 3 of 5

How do you feel you are growing (B)OLDER?
Would you be happy to be interviewed by Jo and appear on video?

Question 4 of 5

I understand that by taking part in this project, I give permission to Jo Blackwell and The Midlife Movement to use my story, my image, full name and age in a video and/or podcast and/or print, and across social media without time limit as part of the (B)OLDER Project.
I will not receive any remuneration for this usage and I also understand that my contribution might NOT be used.

A

I agree

Question 5 of 5

Please upload a high resolution (at least 1mb) photo of yourself to be used to promote your appearance.

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