Summerland Key (IC2R3) Facility Use Request Form - Summer 2023 Revision

Contact information

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* 1. Name of person filling out this Facility Use Request Form

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* 2. Contact details of person filling out this Facility Use Request Form

Email Address

Phone Number

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* 3. Are you any of the following

Lab-tech

Student

Educator

Intern

Other (please specify)

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* 4. Name(s) of person(s) that will be onsite conducting research (Please provide names and affiliations if different)

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* 5. Name of the Institution(s)/Organization(s) (List if multiple)

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* 6. Address of the Institution(s)/Organization(s)

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* 7. What is your funding or grant source (be specific and include funding agency and grant award number)?

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* 8. Main point-of-contact while onsite (if different)

Name

Email Address

Phone Number

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* 9. Please give a short description about the purpose of your visit and your research project, and if a permit is required please include you permit #

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* 10. Please provide the desired arrival and departure dates:

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* 11. Which of Mote's IC2R3 programs are you collaborating with?

Coral Reef Restoration - Dr. Jason Spadaro, Zachery Craig

Coral Reef Monitoring and Assessment - Erich Bartels

Coral Health and Disease - Dr. Erinn Muller, Dr. Grace Klinges, and Marina Villoch

Crab Lab/Grazers - Dr. Jason Spadaro, Owen Hamel

Ocean Acidification - Dr. Emily Hall, Melissa Sante, Amanda Quasunella, and Kyle Knoblock

Meeting Space only

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* 12. Are you Florida Tax Exempt?

Yes

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* 13. If you are Florida Sales Tax Exempt please upload your exemption paperwork

Even if you've provided this info in the past, please upload again. If you are sales tax exempt in another state, you will need to file paperwork to become exempt in Florida.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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