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Thanks for taking the time to share your thoughts. Supporters like you are a pretty big deal around here so we’re really looking forward to hearing from you.

We know your time is valuable so we’ve made this quick and easy to complete.

Thinking about when you first became involved, what best describes your motivation to give*
- I gave in honor of a friend or loved one that has/had mitochondrial disease (mito)
- I can't stand to think of people losing their children to incurable diseases
- I'm personally affected by mito
- I feel it's the right thing to do
- I'm just a generous person and like to give when I'm asked by my friends
- I have a different reason
Will you share the name of your loved one affected by mito?
Please share your reason for giving here
Have you been in touch with the Mito Foundation? Would you like someone to reach out to you to discuss how we could help you?
- Yes I would like to be contacted by Mito Foundation, please contact me via my mobile
- Yes I would like to be contacted by Mito Foundation, please contact me via email
- No thanks, I'm already in touch with Mito Foundation
- No thanks, I'm okay for now
If it were possible to solve one problem for people impacted by mito, what would it be?*
- Focused research that would find a cure for mito
- Increased knowledge for GPs, making diagnosis faster and easier
- Public awareness so mito patients don’t experience the isolation of having a rare unknown disease
- Research findings would lead to the development of treatments to ease the symptoms of mito
- The Australian government would make it possible for parents with mito to have children free from mito
- People with mito would have easy access to the support they need
- I have another problem I would like to solve
Please share the problem you would most like to solve
What areas interest you the most?*
- Advancements in diagnostics techniques
- Support activities to keep people impacted by mito informed and connected
- New approaches to managing mito
- Collaboration with international partners to progress research
- Advocating for the government to support people impacted by mito
- Research and studies into cures for mito
- I'm most interested in another area
Please share what other areas interest you
If you were to tell a friend about the Mito Foundation and why you support our work, what would you say?
If you could share a message of hope with people impacted by mito and their families what would it be?
On a scale of 1 to 10, please indicate how much you agree with each statement with “10” being “Strongly Agree” and “0” being “Strongly disagree”

I am a committed Mito Foundation donor
5

I feel a sense of loyalty to Mito Foundation
5

The Mito Foundation is my favourite charitable organisation
5
Commitment Score 1
Commitment Score 2
Commitment Score 3
Commitment Score Total
Bequests*
- Yes, I already have included the Mito Foundation in my Will
- I intend to include the Mito Foundation when I make or revise my Will
- I would consider this type of gift and would like more information
- I have a Will and have mentioned other charities, but I have not included the Mito Foundation
- I do not have a Will
- I have written a Will but not included a charity
- It’s not something I’m interested in right now, thank you
In a few months, the Mito Foundation will be running a special campaign that will have a huge impact. Do you think you could be in a position to make a special donation of $1,000 or more before the end of the financial year?*
- Yes, I’d like to consider a proposal in more detail
- Maybe. It depends on when, and what campaign
- Not within six months, but maybe a little later or next year
- Not now, thank you
Would you join our special group of Mito Champions supporters by considering this type of donation?*
- I’m already a Mito Champion monthly giver!
- Yes, I am interested in making monthly gifts – please contact me
- Maybe, but I’d like some more information before deciding
- Not right now, thanks
- Name*
  First Last
- Email*
- Mobile Phone*
- 13/06/1975
- Date of Birth
  Date Format: DD slash MM slash YYYY
- Address
  Street Address Suburb State Post Code
Is there anything else you'd like to share with us?

About Us

Mito Foundation supports people affected by mitochondrial disease (mito), funds essential research into the prevention, diagnosis, treatment and cures of mitochondrial disorders, and increases awareness and education about this devastating disease.

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First Name*
Last Name*
Email*
Do you have a connection to mito?*
- I have mito
- My child has/had mito
- My partner has/had mito
- My parent has/had mito
- My sibling has/had mito
- My grandchild has/had mito
- My grandparent has/had mito
- My other family has/had mito
- My friend has/had mito
- I am a medical professional
- I am a researcher
- I have no connection to mito
- I have an other connection to mito
Other Connection to Mito
Comments
This field is for validation purposes and should be left unchanged.

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The Mito Foundation would like to acknowledge the traditional custodians of the land on which we live and work. We pay respect to their cultures and to elders past, present and emerging. We extend that respect to all Aboriginal and Torres Strait Islander peoples today.

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