Online Resource Booking System User Account Request Form

Please submit this form to Centre for Genomic Sciences Admin Office (6-02).

Title : Prof. Dr. Mr. Ms. Mrs.

Last Name :

Given Name(s) :

E-mail :

Please print clearly. Your account information will be sent toyour e-mail address.

Phone No. :

Department :

P.I. Name :

Preferred Login Name:

1st Choice :

2nd Choice :

Data to be Analyzed:

Please contact platform specialists for 2D/DiGE data analysis.

Mass Spectrometry

Pyrosequencing

DNA Sequencing / GeneScan

Real-time PCR (not for instrument booking)

Affymetrix GeneChip

Next Generation Sequencing

Bioanalyzer

iScan

Declaration:

I declare that the information provided on this form is true, accurate and complete. I will also inform the CGS immediatelywhen this user account should be terminated.

User Signature: _______________________________________ Date: _______________________________Day / Month / Year

Note :

You will be informed with your user account and password by e-mail once your request is approved.The CGS reserves the right to approve or reject your request.

Workstations are reserved for analyzing data generated at the CGS.

Please refer to the Privacy and Personal Data Protection Policies at http://cgs.hku.hk/portal/index.php/policies forinformation on personal data protection and handling by CGS.

For Internal Use Only

Approved Rejected

Approved by: ____________________________________ Date: _______________________________

Processed by: ____________________________________ Date: _______________________________

v20171122Centre for Genomic Sciences, The University of Hong KongRoom 6-02, The Hong Kong Jockey Club Building for Interdisciplinary Research5 Sassoon Road, Pokfulam, Hong KongTel : 2831 5500 Fax: 2818 5653