Videoconference enquiry form
Contact details:
Date of enquiry:
Videoconference organiser:
Organisation/school:
Address:
City:
Postal/zip code:
Country:
Contact telephone:
Mobile / emergency telephone:
Email:
How did you hear about us?
Would you like to receive our
education update?
Yes

No

Preferences for videoconference:
If you are requesting more than one videoconference, please complete a separate form for
each one.
Preferred date (1):
Preferred date (2):
Preferred date (3):
Preferred start time:
Preferred finish time or
length of videoconference:
1
Participants:
Number of participants:
Number of teachers (if
applicable):
Age range of group:
School

Postgraduate

Patients

Teachers

Undergraduate

Family

General adult

Academic
researchers

Other

Group type:
If other please specify:
Educational level:
KS3

AS level

BSc

KS4

A2 level

MSc

BTEC

International
Baccalaureate

PhD

Special requirements:
Desired research topics
to be covered:
Special needs /
additional requirements:
Type of videoconference
system and equipment
to be used:
Please return to:
pubengage@wgc.org.uk
Booking Request
Public Engagement
Wellcome Genome Campus
Hinxton
Cambridge
CB10 1SA
2