My dementia or Alzheimer's disease story If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required To help raise awareness and support for NeuRA's research, we tell personal stories about individuals or families living with a disease or disorder of the brain or nervous system. You may have read one of these stories in the past. For example, Amanda's story can be read here. At this time, we're inviting our loyal supporters to share their dementia and Alzheimer's disease stories, by using the form below. With your permission (see check box), we may use extracts of your story on our Facebook or Twitter pages. We may also contact you to speak further about opportunities to partner, which will include an informal interview, a request for photos and video filming. If you have any questions, please feel free to contact email@example.com My story First Name * Last Name * Email (Optional) Phone (mobile or landline) * Are you happy for NeuRA to share your story? Are you willing to travel to Randwick to visit the offices of NeuRA? Are you happy to be filmed (with plenty of notice and support)?