Date

MMUL User Name

MMUL User E-Mail

Address

Supervisors Name

Supervisors E-Mail

Title of Research Project

Investigators Involved

Sponsor at STRI (If any)

Funding Source (If STRI write fund number)

Optimum Dates Requested

Alternative Dates Requested

How Many Times Per Week Will You Be At The MMUL (Aprox. Hours per Day).

Names of Assistants or People Doing Lab Work

Specify Level of Training and Experience of Every Person That Will Work at the MMUL:

Name the Protocol(s) Methods That You Propose To Use

How Many Gels per Week Are You Planning on Running?

Equipment That You Will be Using

List Chemicals That the MMUL Will Have to Provide

List Chemical That You Will Bring With You

Will You Require The Use Of Hazardous Chemicals or Radioisotopes? Specify