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* 1. Title

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* 2. First name

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* 3. Last name

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* 4. Email address

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* 5. Phone number

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* 6. Affiliation

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* 7. Dietary requirements

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* 8. ORCID iD
ORCID provides a persistent digital identifier that distinguishes you from every other researcher, find out more at orcid.org

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* 9. Job Title

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* 10. Research field

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* 11. Research category

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* 12. Please submit title, authors and keywords of your abstract. Provide no more than 5 keywords. Please note that in the case of oversubscription, attendees will be selected based on abstract.

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* 13. Please submit the abstract here (include background, aims, methods, findings and conclusions).
The abstract must be no longer than 2500 characters.

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* 14. Please provide a small biography detailing your career path, current and future work and what makes you excited about interdisciplinary research in this area. This may be published and circulated ahead of the meeting. Must be no more than 1000 characters.

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* 15. Please provide a link from where we can download a photo from you. This may be published and circulated, together with your bio, ahead of the meeting.

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* 16. Gender

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* 17. Nationality

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* 18. Which best describes your ethnic group?

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* 19. Do you regard yourself as disabled?

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* 20. Data Protection
Information that you have supplied within this application will be used to process your application and for the purposes of any audit and/or evaluation. Your personal data will be stored in accordance with the General Data Protection Regulation 2018. For more information see our privacy policy: https://acmedsci.ac.uk/privacy-policy

The Academy may publish basic details of your application and/or your participation in any scheme and/or anonymise your personal data for research and statistical purposes. The Academy may release details of successful applications (including your name and institution) into the public domain (in whatever media).

By agreeing to this Privacy Notice and Statement, you have explicitly consented to your personal data being processed by the Academy in the way set out above*

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