UMCG Flow Cytometry Facility Registration

UMCG Flow Cytometry Facility Registration
Name*

First NameLast Name
Date of birth*

DayMonthYear
Date
Email*
example@example.com
P or S number*
Please provide the barcode number on your UMCG pass for access to the lab*
Qualification*

MLO/HLO studentTechnicianMSc studentPhD studentPostdocOther
Local Phone Number

Area CodePhone Number
Mobile Phone Number

Area CodePhone Number
Group Leader (PI)*
Daily Supervisor Contact person*
Email Group Leader*
example@example.com
Email Daily Supervisor*
example@example.com
Faculty/Department*
Projectcode for billing*
Requested date of access From

DayMonthYear
Date
To*

DayMonthYear
Date
Experience in Flowcytometry?*
Request training for
Request access for
Facility related GMO numbers if applicable
IG- or IT- numbers
Please provide information about the applications, sample types, number of colors you plan to use*
Please upload a copy of your LMS ML-II/BSL-2 laboratories access and activities with microorganisms. (Note! only the e-learning Access and Actvities will be accepted!)*

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Please verify that you are human*
By submitting this form I confirm the completeness and accuracy of the provided information above. I also accept the billing and understand and accept the rules of the Flow Cytometry Facility.
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