Expressions of interest (General participation) Survey

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* 2. Full name

First Name (e.g. Albert, Marie, Françoise, Katherine, Richard...)

Last Name (e.g. Einstein, Curie-Skłodowska, Barré-Sinoussi, Johnson, Feynmann...)

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* 3. Organization
(e.g. European Schoolnet, European Commission, University X, School Y, Company Z...)

Organization

Address

City/Town

ZIP/Postal Code

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* 4. Country of organization

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* 5. Please select the role that best describes you

Teacher

Researcher

Director

Project Manager

Policy maker

Industry representative

Head of school

Other (please specify)

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* 6. Terms and conditions

	No	Yes
I understand that to process my application, collection and storage of personal data (name, surname, email address) is necessary. Access to this information is strictly limited to European Schoolnet and will only be used for this specific purpose. European Schoolet will have access to account information provided by the user and can modify and/or delete information upon request	I understand that to process my application, collection and storage of personal data (name, surname, email address) is necessary. Access to this information is strictly limited to European Schoolnet and will only be used for this specific purpose. European Schoolet will have access to account information provided by the user and can modify and/or delete information upon request No	I understand that to process my application, collection and storage of personal data (name, surname, email address) is necessary. Access to this information is strictly limited to European Schoolnet and will only be used for this specific purpose. European Schoolet will have access to account information provided by the user and can modify and/or delete information upon request Yes
I understand Scientix will NOT organize or cover my flight.	I understand Scientix will NOT organize or cover my flight. No	I understand Scientix will NOT organize or cover my flight. Yes
I would like Scientix to organize and cover my hotel from Friday to Sunday, if selected.	I would like Scientix to organize and cover my hotel from Friday to Sunday, if selected. No	I would like Scientix to organize and cover my hotel from Friday to Sunday, if selected. Yes
I understand that Scientix will organize and pay for meals from Friday dinner to Sunday lunch, if selected.	I understand that Scientix will organize and pay for meals from Friday dinner to Sunday lunch, if selected. No	I understand that Scientix will organize and pay for meals from Friday dinner to Sunday lunch, if selected. Yes
I understand the list of participants will be published online (only name, surname and country).	I understand the list of participants will be published online (only name, surname and country). No	I understand the list of participants will be published online (only name, surname and country). Yes
I understand that during the event, pictures and video, where I will possibly be clearly identifiable, will be taken. This material will be used for dissemination purposes (i.e. press, brochures, web portal).	I understand that during the event, pictures and video, where I will possibly be clearly identifiable, will be taken. This material will be used for dissemination purposes (i.e. press, brochures, web portal). No	I understand that during the event, pictures and video, where I will possibly be clearly identifiable, will be taken. This material will be used for dissemination purposes (i.e. press, brochures, web portal). Yes
I understand I will be informed if I have been selected to participate in the 3rd Scientix conference between the 9 and 11 of April 2018	I understand I will be informed if I have been selected to participate in the 3rd Scientix conference between the 9 and 11 of April 2018 No	I understand I will be informed if I have been selected to participate in the 3rd Scientix conference between the 9 and 11 of April 2018 Yes
I understand European Schoolnet / Scientix will be responsible of selecting the participants and will not enter into any discussion on the results.	I understand European Schoolnet / Scientix will be responsible of selecting the participants and will not enter into any discussion on the results. No	I understand European Schoolnet / Scientix will be responsible of selecting the participants and will not enter into any discussion on the results. Yes

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* 7. Have you participated in a previous Scientix event?

No, this would be my first time

The 1st Scientix conference (6 - 8 May 2011)

The 2nd Scientix conference (24 - 26 October 2014)

A Science Projects Workshop in the Future Classroom Lab

A National Scientix workshop

Other (please specify)

Expressions of interest (General participation)

Information on interested participant

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* 1. Email address

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* 2. Full name

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* 3. Organization
(e.g. European Schoolnet, European Commission, University X, School Y, Company Z...)

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* 4. Country of organization

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* 5. Please select the role that best describes you

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* 6. Terms and conditions

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* 7. Have you participated in a previous Scientix event?

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* 8. Why would you like to participate?

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* 1. Email address

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* 2. Full name

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* 3. Organization(e.g. European Schoolnet, European Commission, University X, School Y, Company Z...)

Question Title

* 4. Country of organization

Question Title

* 5. Please select the role that best describes you

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* 6. Terms and conditions

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* 7. Have you participated in a previous Scientix event?

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* 8. Why would you like to participate?

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* 3. Organization
(e.g. European Schoolnet, European Commission, University X, School Y, Company Z...)