Volunteer Application Form Stages - FluCamp

Make a difference today.

Stage 1 of 5

Having this information helps us to correctly identify you, and means that we can get in touch promptly if we need to.

Contact Details

Male Female
Maximum of 11 digits. Avoid spaces.
(e.g. 07912345678 or 02077561414)

Address

Enter your postcode to automatically find and fill your address details.

Change address

For international volunteers outside of the UK only

How would you like to be contacted?

Email

SMS

Phone

How would you like to be contacted?

Email

SMS

Phone
NEXT: YOUR SUITABILITY
Stage 2 of 5

The answers you give us in this ‘Yes or No’ section help us to work out if you’re suitable for a FluCamp study. Please read each question carefully, and answer as best you can.

Your Suitability

London Yorkshire Coventry

*Please note Yorkshire & Coventry are for first screening appointments only. Any subsequent appointments would be in our London facility.

Driving licence or Passport only

e.g. Cannabis, Valium, Heroin, Cocaine, Legal Highs. Excludes Nicotine.

NEXT: ABOUT YOU
Stage 3 of 5

Tell us a little more about yourself. Your height and weight allows us to calculate your BMI - which is an important part of the selection process for potential volunteers.

About You

  • Your Height

    Centimetres Feet & Inches

  • Your Weight

    Stone & Pounds Kilograms
NEXT: YOUR MEDICAL STATUS
Stage 4 of 5

Letting us know more about your medical history means that we can determine which clinical studies you will be best suited for. Please remember to answer this 'Yes or No’ section honestly, and double check that your answers are correct.

Your Medical Status

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0 months 1 month 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 21 years 22 years 23 years 24 years 25 years 26 years 27 years 28 years 29 years 30 years 31 years 32 years 33 years 34 years 35 years 36 years 37 years 38 years 39 years 40 years 41 years 42 years 43 years 44 years 45 years 46 years 47 years 48 years 49 years 50 years 51 years 52 years 53 years 54 years 55 years 56 years 57 years 58 years 59 years 60 years 61 years 62 years 63 years 64 years 65 years
1 to 5 6 to 10 10 to 20 21+
NEXT: GETTING IN TOUCH
Stage 5 of 5

The information you provide in this section allows us to keep in contact with you throughout your FluCamp experience.

Getting in Touch

Morning Afternoon Evening Anytime
Facebook Instagram Internet search (such as Google) Radio Outdoor Advertising (such as Tube, Train, Washroom) Spotify Friend or Family Member Newspaper or Magazine Email Flyer/Hand out GP Other Don't know
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