Center for immunobiology New Core User Form

Principle Investigator Contact Information

Institution Name:

Department:

Position Title:

E-mail Address:

Phone Number:

Address Information

Core Users and/or Additional Personnel Information

- Person One -

- Person Two -

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Please indicate all WMed core equipment for which you are requesting access. Briefly describe how equipment will be used to further your research goals.

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Please indicate if any of the following are present in specimens you would bring into to the WMed core. Choose all that apply.

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Questions, comments and/or concerns?

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