FameLab® Registration Form

Welcome to FameLab Greece – one of the components of the International FameLab:

www.britishcouncil.gr

Please complete this form, which will not be seen by the judges before your audition.

Indicate which of the two qualifying round venues is more convenient for you by ticking the appropriate box:

Athens: Monday 7 April 2014

Τhessaloniki: Tuesday 8 April 2014

Firstly, some information about you:

Title: ______Name: ______

Email address: ______

Contact telephone: ______Your home postcode: ______

Your home address: ______

Your position and organisation: ______

What is your highest scientific or technical qualification? (Please specify e.g. BSc, MSc, PhD)

______

Which scientific field/area of research do you work in? ______

______

Please give us a short biography (approx.. 50 words)

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______
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______
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______

How many years have you worked in the area of research? ______

Is your work funded by an organisation? ______

Approximately how many kilometres will you have to travel to attend the competition?

______

Secondly, some questions about FameLab:

1.  How did you hear about FameLab?

2.  Please explain why you have decided to enter the competition and what you hope to gain professionally and/or personally.

3.  What scientific subject have you chosen for your presentation and why?

4.  Please explain how you have researched and prepared the material for your presentation.

Thirdly, some questions about your previous science communication experience:

5.  Not including FameLab, have you ever been involved in science communication activities aimed at non-specialist audiences (e.g. the public, school groups or families)?

Yes No Not sure

6.  Please indicate how many (if any) of the following science communication activities aimed at non-specialist audiences (e.g. the public, school groups or families) you have been involved with during the last year:

Activity / How many in the last year?
Lectures/presentations as part of your job
Lectures/presentations in addition to your job
Role model schemes
Science festivals
Open days/fun days
Activities at museums or science centres
Television
Radio
Science Writing
Other
Other
Other

Finally, some more questions about you:

7.  We may want to contact you at a later date to ask your opinion of FameLab. Please indicate if you would be willing to be contacted in either or both of the following ways:

Email Telephone

8.  We may want to use your e-mail address to send you details of British Council activities, services and events (including social events) which you may find of interest.

Yes, I would like to receive details of British Council activities, services and events.

9.  Would you be happy for us to pass your details to science communication or media organisations that might be able to offer you other opportunities in these fields?

Yes, please. No, thanks.

10.  Are you:

Male Female

11.  Please indicate your age:

18–20 21–24 25–34 35–44 45+

Disclaimer: The British Council and the competition venue are not liable for any loss or damage to property whilst at the event or travelling to the event, nor for personal injury or death unless due to the applicable party’s negligence.

Signed: ………………………………………………………… Date: ……………………………

Please send the completed form by post, fax or email to:

Athens
Katy Yakoumaki
British Council
17 Kolonaki Square
106 73 Athens
Telephone 210 369 2342
Fax 210 361 4658
Email / Thessaloniki
Chrysoula Melidou
British Council
PO Box 12004
541 01 Thessaloniki
Telephone 2310 378 314
Fax 2310 282 498
Email

Deadline for receipt of registration forms: Monday 31 March 2014

Thank you and good luck!

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