Tropical Marine Biology Option

Session 2011–2012

I would like to apply for a place on the Tropical Marine Biology Option & Field Course in the autumn. I understand that in order to attend the field course component of the Option, I shall be required to:

  1. provide all of the details as specified on page 1 of this form
  2. complete the health and fitness questionnaire on page 2 of this form
  3. make a contribution of £900 towards the cost, payable immediately
  4. complete a course of training in basic snorkelling (even if a qualified diver)
  5. attend any/all of the information sessions prior to the field course

Any information supplied is protected by the Data Protection Acts and will remain confidential to the University of Glasgow.

* Compulsory, must be filled in.

1 Please note that your NAME(S) must be exactly as shown on your passport.

Surname 1
* As it appears on your passport
Forename(s) 1
* As it appears on your passport
Date of Birth
Place of Birth (Town)
Degree Course
Mobile Phone Number
Home Email Address
Nationality
Passport Number
Passport Expiry Date
Term Address
Telephone Number
   
Summer Address
Telephone Number
   
Name, Address of General Practitioner
Telephone Number
   
Name, Address of Next of Kin
Relationship
Telephone Number
   

 

Health & Fitness Questionnaire

 
No
Yes
1. Are you physically fit?
   
2. Are you able to swim 10 x 25 m lengths of the swimming pool with ease?
   
3. Have you completed a snorkelling training course in the past?
   
4. Are you a trained diver?
   
5. Do you suffer from any allergies? If so, to what?
   
   
6. Are you currently taking any medication (other than the contraceptive pill)?
   
7. Are you currently receiving medical care or have you consulted a doctor in the last year for anything other than a trivial infection or minor injury?
   
8. Do you suffer from any condition that would prevent your full participation in this field course, including participation in water-based activities? 2
   
9. Do you suffer from any condition that might require medical intervention during this field course?
   

2 Relevant conditions include, for example, severe asthma or any other chest or lung complaint; previous chest or heart surgery; high blood pressure; fainting, blackouts or recurrent dizziness; epilepsy or fits; diabetes; regular ear, nose or sinus problems; or any other condition that might impair your capacity for physical activity on land and in water.

(If you have answered ‘YES’ to any of questions 6–9, you may be contacted by the field course organisers for clarification.)

Motivation: Please state why you are interested in this option