Request Form

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Annex 2. Request for the Distribution of Genetic Resources (DNA) To: The Director of the Mediterranean Forest DNA Bank Date: ____________________ Name of Applicant ____________________________ Affiliation / Organization ______________________________________________ Public organization or equivalent Others (Private company, etc.) Department/Institution ___________________________________ Address ________________________________________________ ________________________________________________ Country ___________________ Postal code _______________ Tel. ___________________ Fax ___________________ E-mail ___________________ I hereby apply for the distribution of the following genetic resources (DNA): ___________________ ___________________ ___________________ ___________________ ___________________ Title of research ___________________________________________________________________ ___________________________________________________________________ Recent publication ___________________________________________________________________ ___________________________________________________________________ Attached Sheet to subscribe conditions for distribution of Genetic Resources (DNA)

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Request form for providing DNA samples

Transcript of Request Form

Page 1: Request Form

Annex 2.

Request for the Distribution of Genetic Resources (DNA)

To: The Director of the Mediterranean Forest DNA Bank

Date: ____________________

Name of Applicant ____________________________ Affiliation / Organization ______________________________________________ � Public organization or equivalent � Others (Private company, etc.) Department/Institution ___________________________________

Address ________________________________________________ ________________________________________________

Country ___________________ Postal code _______________

Tel. ___________________

Fax ___________________

E-mail ___________________ I hereby apply for the distribution of the following genetic resources (DNA):

___________________ ___________________ ___________________ ___________________ ___________________

Title of research ___________________________________________________________________ ___________________________________________________________________ Recent publication ___________________________________________________________________ ___________________________________________________________________

Attached Sheet to subscribe conditions for distribution of Genetic Resources (DNA)

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