Register your interest

This survey is to register your interest in receiving a free The Departure Lounge flatpack. The Departure Lounge is an ambitious public engagement project run by the Academy of Medical Sciences to encourage people to talk openly about death and dying. We aim to have the flatpack available for Dying Matters Week 2019.

The Departure Lounge flatpack will be a suitcase-sized package containing information and stimulus materials for facilitating conversations about death and dying. The flatpack is free but limited numbers are available. Bursaries of up to £250 are available to support events using the flatpack.

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* 1. Title

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* 2. First name

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* 3. Surname

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* 4. Contact email

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* 5. Current job title

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* 6. Location (nearest town/city)

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* 7. Please briefly describe any activities you have done for previous Dying Matters weeks.

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* 8. Please briefly outline how you imagine you would use The Departure Lounge flatpack.

This might include details of any of the following: venue(s), location(s), anticipated audience, any collaborating people or organisations, anticipated time spent working with flatpack, connections to existing groups, etc. 

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* 9. Please confirm that you would be willing to assist in evaluation of people's responses to the flatpack. This would be in the form of short surveys or similar provided by the Academy.

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