Cedarlane CA New Lab Startup Program

New Lab Contacts and Address Info

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1. Please provide shipping address information for your new lab.

Lab/Team Name

Institution/Company

Shipping Address

Room#/Dept.

City/Town

Province

Postal Code

Country

General Lab Email Address (if applicable)

Main Lab Phone Number (if applicable)

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2. Principal Investigator (P.I.) Info

Name

Email Address

Phone Number

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3. Lab Manager Info

Name

Email Address

Phone Number

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4. Primary contact info, relative to this new lab program.

Name

Email Address

Phone Number

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5. Name and email address of other team members (for validating prize pack request)

Lab member 1 (name / email)

Lab member 2 (name / email)

Lab member 3 (name / email)

Lab member 4 (name / email)

Lab member 5 (name / email)

Lab member 6 (name / email)

Lab member 7 (name / email)

Lab member 8 (name / email)

Lab member 9 (name / email)

Lab member 10 (name / email)

Question Title

* 1. Please provide shipping address information for your new lab.

Question Title

* 2. Principal Investigator (P.I.) Info

Question Title

* 3. Lab Manager Info

Question Title

* 4. Primary contact info, relative to this new lab program.

Question Title

* 5. Name and email address of other team members (for validating prize pack request)

1. Please provide shipping address information for your new lab.

2. Principal Investigator (P.I.) Info

3. Lab Manager Info

4. Primary contact info, relative to this new lab program.

5. Name and email address of other team members (for validating prize pack request)