Skip survey header

Amputee application for documentary

Page One

TERMS AND CONDITIONS Thank you for filling out this application form to be part of the documentary. Please understand by completing this application you are granting Altlimbpro permission to use your information for the following. 1) To use as a way of selecting candidates for the documentary 2) Your information may be used in the documentary its self (even if you are not chosen) . 3) To attract funding bodies and sponsorship for the making of the documentary 4) Any information you give us could also be used in the future beyond the documentary as a way of attracting sponsorship and further support the work of Altlimbpro. No information will be passed onto any third parties that have nothing to do with the work of Altlimbpro
4. What is your gender ? *This question is required.
12. What features appeal to you ? *This question is required.
Please can you send a high resolution photograph of yourself (preferably a full length photo) to info@altlimbpro.com please include your full name in the email so we can match it to your application form. Thank you :)
Survey Software powered by SurveyGizmo
Survey Software