NHS Great Ormond Street Hospital for Children

4th Annual NIHR GOSH BRC Image Competition - A Moment of Discovery

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1. Full name *

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2. Email address *

3. Phone number (we will only contact you if we cannot reach you by email)

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4. I am (select all that apply): *

Undergraduate
PhD Student
Post-Doctoral Researcher
Principle Investigator
Nurse
Doctor
AHP
Other (please specify):

5. Who is the project funder (if any)?

6. Who is the Principle Investigator of this project (if not you)?

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7. What is your affiliation? *

GOSH
NIHR GOSH BRC
UCL Great Ormond Street Institute of Child Health (UCL GOS ICH)
UCL Institute of Cardiovascular Science (UCL ICS)
Sheffield Children's Hospital
Alder Hey Children's Hospital
Birmingham Children's Hospital
Other (please specify):

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8. What title and name would you like to be referred to in communications about the competition? *

9. How did you hear about this competition?

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