Application for Center Use

Application for use of the BioCurrents Shared Resource

All scientists interested in visiting the Resource should complete this form and submit it electronically or mail it to the address below (attn: Mark A. Messerli, Ph.D.) Visitors to the BSR have all the privileges of regular MBL visiting scientists who rent laboratory space. BSR visitors must cover all consumable costs relevant to their research. The BSR provides laboratory space, rig access and technical support.

**Please Note: There may be difficulties submitting this form from certain browsers and email programs. If you do not receive a confirmation from the BRC within 3 days, please send the below requested information directly to mmesserli@mbl.edu within an email message. Thank you.**

Section 1: Individual's Information

Full name:

FAX #:

Ed. Degrees:

E-mail:

St. Address or P.O. box:

Home Institution:

City:

Position:

State, Zip Code:

Funding Source:

Country:

P.I. on Grant:

Telephone:

Grant Number:

Proposed Dates:

Section 2: Purpose of Work

Please fill in the following fields:

Title of proposed work:

What are your overall research goals and and what are the specific aims?

What preliminary studies, if any, have been carried out with the Resource?

What specific aims do you propose, using BSR facilities?

Describe the preparation:

Additional comments:


Please Note: There may be difficulties subitting this form from certain browsers and email programs. If you do not receive a confirmation from the BRC within 3 days, please send the above requested information directly to psmith@mbl.edu within an email message. Thank you.