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IMPACT Ambassador Scheme
Please complete this form to register your interest in becoming an IMPACT ambassador!
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Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Email
*
Professional Background (the role that most closely aligns to your current position)
*
Fire and Rescue Service
Ambulance Service
Air Ambulance organisation
Police
Other
Professional Title or Job title (The most relevant to post-collision care)
Name of Organisation
Country organisation is based in
Postcode of organisational headquarters (if UK based)
What is your current involvement in post-collision care?
Title contacted Name
Would you be willing to have your name and title displayed on the IMPACT website?
*
Yes
No
Would you be willing to be contacted about upcoming research opportunities?
*
Yes
No
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