Part One

Please register your application by completing the web form below. The information requested forms Part 1 of the application process.

Please make sure you have filled in the mandatory fields:(*)
First name, Last name and email.

APPLICATION FORM PART ONE

First Name:*
Last Name:*
Title:
Telephone Number (business):
Telephone Number (mobile):
Email:*
Fax:
Name of Organisation:
Job Title:
Contact Address:
Have you ever registerd with Ethical Tissue before?: Yes No
Please include a short outline proposal of your intended biomedical research work (approx 100 words):
Any other relevant bio-sample information:

BIO-SAMPLE REQUIREMENTS

Bio-sample required (lung/prostate/blood/urine etc):
Normal/Disease specific (please name):
Bio-sample format– please specify bio-sample format e.g. snap frozen tissue/blockss/sections/cells/
microarray/culture/cell pellet etc:
Amount of bio-sample required (number of sections/number of cells/weight in grams/volume etc:
Other specific requirements e.g. grade and stage of tumour/histological diagnosis/etc:
Exclusion criteria (e.g. viability etc):
Any other relevant bio-sample information:
 

Please make sure you have filled in the mandatory fields:(*)
First name, Last name and email.