Entr y for m
Completed forms should be submitted to [email protected] as a word
document (not a PDF).
Entrant’s details:
Title:
Name:
Date of birth:
Job title (if applicable):
Name of institution:
Work Address:
Work phone:
Home address:
Mobile/home phone:
Email:
Twitter handle (if applicable):
Start date of research studentship:
Title of PhD:
From time to time we may contact you about other science writing opportunities or activities and
initiatives of interest to PhD students and early-career researchers. If you do not wish to be
contacted please check the box ☐
The MRC Communications Team may wish to contact you in relation to your research for the
purpose of promoting the MRC. If you do not wish to be contacted please check the box ☐
Supervisor/grant holder/manager details:
Title:
Name:
Job title:
Name of institution:
Work Address:
Work phone:
Email:
Signatures:
Entrant:
By inserting an e-signature/typing my name I confirm submission of
my article to the 2016 MRC Max Perutz Science Writing Award. I
also acknowledge that my article and name may be used for
promotion of the award.
Non-disclosure agreement: I agree that I will not share
confidential information about the competition or competition
winner prior to an official announcement by the MRC.
Signature:
Supervisor/grant holder/manager
Signature:
By inserting an e-signature/typing my name I confirm that the
above information is true and that this researcher is funded by the
Medical Research Council
2016 MRC Max P erutz Sci ence W riting A ward – artic le
Please insert your article below (no more than 800 words), together with your name and the title of
your article.
Please ensure your text is 1.5 spaced Arial 10pt.
Name:
Title: