Name:
College/school:
Date of Birth (dd/month/yy):
Home Address Line 1:
Home Address Line 2:
Home Address Line 3:
Post Code:
 
em@il:
Confirm em@il:
Telephone:
 
Category: A work of fine art
Digital art/animation/game
 
Topic: Diversity or Disorder
The (St)ages of the Brain
I would like to discuss this with you
 
Please give details of your current GSCE/AS/A-level courses and your relevant hobbies and interests:
 
Are you interested in a summer placement? Yes
No
 
Can we publish your photo on our website or in the press? Yes
No
 
We are more than happy to discuss the projects and talk about the science with you. If you have any comments or questions, please enter them below.
Comments / Questions: