Registration – Breakthrough Prize

First Name*

Surname*

Address*

First Line Second Line City/Town County/Region Postcode Country

Email*

Enter Email Confirm Email

Phone*

Gender

Male
Female
Other

Age at 2 March 2021

Occupation

Are you eligible for a student category? (Have you been enrolled in full time education for at least one month during the period 30th Nov 2020 to 2nd Mar 2021? See competition rules paragraph 4.1 for more details)*

Yes
No

Are you a School Student or a University Student?*

School
University

Name of University and course being studied*

Name of School and course being studied*

Are you the sole author for your entry?*

Yes
No