Core Resources Request Form

Investigator Information
First Name(*)
Please enter the Investigator's first name

Last Name(*)
Please enter the investigator's last name

E-mail(*)
Please enter a valid email address

Phone(*)
Please enter a phone number

Institution(*)
Please specify your institution

Address(*)
Please enter your address

City(*)
Please enter your city

State/Province

Zip/Postal Code
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Country
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Are you requesting live animals?(*)
Required

Veterinarian Information
Name(*)
Please provide the name of your veterinarian

Email(*)
Please provide the email address for your veterinarian

Phone(*)
Please provide the phone number for your veterinarian

Live Animal Shipping Coordinator Information
Name(*)
Please provide the name of your shipping coordinator

Email(*)
Please provide the email address of your shipping coordinator

Phone(*)
Please provide the phone number for your shipping coordinator

Attach Request(*)
Please attach your service request in .PDF, .DOC, or .DOCX format.

Please attach a PDF or Word (.doc or .docx) document with a short description of the service or resource you are requesting. If requesting biological materials, please indicate how you want samples prepared, stored, and shipped

UAB MTA Agreement(*)
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Please download and attach a UAB MTA form (.doc)

Acknowledgement(*)

We ask that you acknowledge the Hepatorenal Fibrocystic Disease Core Center (P30 DK074038) on publications or presentations that utilize our Center's services or resources. The Center will be happy to provide letters of support for grant applications that propose to use Core services or resources.

(*)
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