FameLab Application Form Step 1 of 9 11% Personal detailsPlease enter your email address* Confirm your email address* Title*DrMrMrsMsProfYour name* First Last Your Address* Street Address City State Postcode AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Best contact phone number*Your age*18-2425-3435-4445-5455-64Over 65Your gender*FemaleMalePrefer not to sayOtherAre you of Aboriginal or Torres Strait Island origin? Yes No Prefer not to say The information that you provide will be used for statistical and reporting purposes only. Your experienceYour organisation / institution*Your positionAre you currently studying?* Yes No What is your highest scientific or technical qualification?*BSc, MSc, PhD etcWhat is your field or area of research / study?*PhysicsChemistryBiologyMedicineEngineeringMathsInformation technologyOtherChoose onePlease provide a short biography*Have you previously participated in FameLab Australia?* Yes No FameLab entryWhy did you decide to enter FameLab?*Promote my work / researchPromote science generallyGain experience / practice public engagementObtain advice / feedbackFor enjoyment / funTo learn new skillsAttend master classMake new contacts / networkingEnhance my careerTo win the competitionOtherChoose oneHow did you hear about FameLab Australia?Foundation for the WA MuseumBritish CouncilUniversity / organisationPrinted marketing (flyer, poster)Online (FameLab website, Facebook, Twitter)Through a colleague / friendOtherChoose oneWould 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 No Presentation detailsPresentation title*Overview of your research or project*FameLab is about making science fun and presenting scientific concepts in a way that will be understandable to a lay audience. In 200 words or less and in plain English, please provide us with an overview of your research or project and what makes it unique. Things to consider - What is your research/project? Who will your project benefit? What makes your research unique – e.g. what potential does it have; who will it impact; have you uncovered any surprising facts?Please let us know of any previous science communication experienceResearch / Projects that you have undertakenUse the plus sign at the end of this line to add projects individually It is a requirement of FameLab Australia that evidence has been provided of research/projects that you have undertaken. Please provide us with the links and titles of any relevant sources of evidence. This may include publications, conference titles, conference posters or evidence of internal review from a Director / Dean / Head of your organisation. Referee detailsPlease provide the details of one referee who can verify or comment on your research and results. This might be someone who has peer reviewed your work, a supervisor, a director or dean of your institution or an employer.Referee name*Referee Position*Referee Organisation*Referee Phone number*Referee Email* I give permission for the Foundation for the WA Museum to contact my referee Video entryIn your video pitch, you may convey your ideas using small props, song, dance… anything you think might help to get your message across in an engaging way, BUT you may NOT use electronic media. That means no slides, charts, printed images or PowerPoint displays. And try to keep the jargon to a minimum – an audience of non-scientists should be able to understand what you’re saying without having to hit the books first! Your video should: be up to 3 minutes long (content after this time limit will not be judged); not include editing or special effects, other people or excessive props. Please do not password protect your video. You may, however, wish to change the settings of your video so that only those who have been given the URL will be able to see it. If using YouTube, select ‘Unlisted’ in your video’s privacy settings. PLEASE NOTE: Don’t worry too much about having a polished ‘performance’ in your video. We really just want to meet you and to see how passionate you are about science. Don’t stress, either, about the recording quality of your video – clips filmed in natural light, on your phone or iPad are fine.Pleae provide a video URL to support your application* Your video should be in YouTube format Which days to attend?Please select all the semi-final events you are able to attendI am available to attend the following semi-final eventsQueensland Museum, Brisbane - 20 MarchMuseums Victoria, Melbourne - 27 MarchPowerhouse Museum, Sydney - 10 AprilWA Maritime Museum, Fremantle - 17 AprilPlease select all that apply. Hold down CTRL and click for selection. Privacy and terms - Data protection noticeThe British Council and the Foundation for the WA Museum (FWAM) will use the information that you are providing exclusively for the needs of this competition, for statistical purposes, as well as for communication with the winner. As part of the FameLab competition, successful applicants' information may be made available on the British Council Australia website. This means that your information will be made available worldwide, including in countries which do not have equivalent data protection laws. The British Council and FWAM would like to use your information to send you details of our activities, services and events (including social events) which might be of interest to you.Yes, I would like to be sent details of British Council and Foundation for the WA Museum (FWAM) activities, services and events, please contact me by email We cannot send you any information if you do not tick this box. You may opt out at any time. Your privacy is important to the British Council and FWAM and we’re committed to preserving the confidentiality of our contacts’ personal information and undertakes not to divulge any of the contacts’ personal information to any third party without the prior consent of our contacts. Under the UK Data Protection law and the Australia Privacy Act you have the right to ask for a copy of the information we hold on you, and the right to ask us to correct any inaccurate information. If you want to find out more about this please contact the British Council office or see our website. Event photographyIf my application is successful, I understand that the British Council and the Foundation for the WA Museum may gather photographs and audio-visual material of me in relation to the FameLab competition.I hereby give permission for these materials to be used for the purposes of internal and external promotion by the British Council, the Foundation for the WA Museum and any partners and other third parties with which the British Council works.