NMDMF Booking Form

User name

Title

First Name

Last Name

Contact Details

Phone Number

Email^*

Fax (optional)

Physical Address

Address Line 1

Address Line 2

City

State or Region

Country

Zip

Postal Address

Postal Code

Position

Position - please select one

Organisation

Organisation Name

Project Details

Description

Which instruments are you interested in or are intending to use?

Shipping

Is shipping required

Yes
No
Unsure

What are the preferred shipping conditions?

Room Temperature
Cold
None
Unsure

Are import permits required?

Ethics

Does this research involve animal or human subjects?

If yes, has ethical approval been granted?

If yes, please provide your ethics approval number

If yes, has the CPGR been included on your ethics?

If ethics has not been granted, please explain how the matter is being dealt with.

Please note that a copy of your ethical clearance certificate must be submitted to the CPGR. If ethics cannot be provided or does not cover the scope of this study, the project will not be initiated. The certificate can be scanned and emailed to your assigned project manager.

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