UMCG Flow Cytometry Facility Registration

UMCG Flow Cytometry Facility Registration
Name

First NameLast Name
Date of birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Email
example@example.com
P or S number
Please provide the barcode number on your UMCG pass for access to the lab
Qualification

Other
Local Phone Number

Area CodePhone Number
Mobile Phone Number

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

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
To

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
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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Include Name and Date Cancelof
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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