NSRRC | Receiving Investigator Application Form

Receiving Investigator Application Form

The information requested below is confidential and will be used to help ensure that swine are shipped to and used by organizations that have appropriate staff and housing to care for these animals.

* = required information

Institution/Organization
	Name:
	Type:	For Profit Non-Profit Tax Exempt No.:
Investigator Contact Information
	Name:	*
	Phone:	*
	Fax:
	E-mail:	*
Billing Information
	ATTN:
	Address:

	City:
	State/Province:
	Zip/Postal Code:
	Country:
	Phone #:
	Purchase Order #:
NSRRC Product Use Limitations
Any recipient of swine or genetic material from the NSRRC agrees to the terms and restrictions of the NSRRC Outgoing MTA. Recipient and institutional official must execute the NSRRC Outgoing Material Transfer Agreement (MTA) before the request will be shipped.
Animals Requested
(quantities are limited)
	Line Requested:	*
	Number of Live Males:	(number only)
	Number of Live Females:	(number only)
	Number of Straws (20 Cryopreserved Embryos per straw):	(number only)
	Other (e.g. tissue):
Attending Veterinarian or Contact Person for Animal Shipment Authorization (Animals will not be shipped until the NSRRC receives authorization for animal receipt by the Receiving Investigator's institution.)
	Name:
	Phone:
	E-mail: