Imagining The Brain 2012

Personal Details

Please ensure that you the contact details you enter are valid and that you can be reached on them during the summer holidays

Name^* College^* Date of Birth^*
(dd/mm/yyyy) Home Address^* Post Code^* Email^* Telephone^*

Your Artwork

Category^* A work of fine art Digital art/animation/game

Topic^* Getting On Your Nerves Autism Spectrum Conditions Other: I would like to discuss this with you

Title^* Please give a title for your piece

Description^* Please give a brief description. These will accompany the exhibition of your work and be linked to your work on our website. Also note that judges are keen to see Supporting Artwork. Please also give details of your current GSCE/AS/A-level courses and your relevant hobbies and interests:

Are you interested in a paid summer placement?^*

Please make sure your contact details are valid for the summer holidays if you are interested in the placement!

Yes No

Can we publish your photo on our website or in the press?^* Yes No

Comments / Questions: 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.