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Emergency Information Form for Techscaler Silicon Valley - October 2026

Please complete this form by 12 noon Thursday, 16th July (UK time). Your answers to this form can only be accessed by the following CodeBase Team Members to ensure the delivery of the programme:
- Anaïs Guillemaud, Head of Scaleup Acceleration Programmes
- Jessica McClure, International Programme Manager
- Jennifer Forbes Iannolo, VP of Business Acceleration Programmes
- James Stanyer, Programme Coordinator - Accompanying CodeBase/Techscaler Staff
The answers you submit in this form will be collected via Tally and stored on Google Drive and deleted by 1 January of 2027, following the completion of the Techscaler Silicon Valley Programme.

Your full name

Your email address

Your phone number

Do you have any medical and/or accessibility information you'd like us to know? This can include any food allergies or dietary requirements you may have

Your emergency contact's name

Your emergency contact's relationship to you

Your emergency contact's phone number.

Is there anything else we should know about your emergency contact?

Do you need a visa in order to enter the USA?

We are collecting this information to provide those needing a visa with additional information regarding flight bookings. Unsure of your entry requirements? See here. Please note: - Needing a visa to enter the USA does not impact your place on this programme. - It is the participant's responsibility to sort their entry requirements.
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