Summerland Key Facility Use Request Form - FURF

Contact information

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

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* 2. Name of person conducting research

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* 3. Name of your Organization

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* 4. What is your funding or grant source?

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* 5. Are you any of the following

PI Student

Lab-tech

Grad Student

Educator

Other (please specify)

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* 6. Address

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* 7. Contact details of person filling out FURF

Email Address

Phone Number

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* 8. Contact details of person conducting research

Name

Email Address

Phone Number

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* 9. Please give a short description about the purpose of your visit

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* 10. Is this project or program in collaboration with Mote?

Yes

No

If "Yes" please be specific on details

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* 11. Are you Florida Tax Exempt?

Yes

No

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* 12. Billing address same as above

Yes

No (please add billing address)