User Qualification Form for the Confocal LSM 510 with Zeiss Inverted Axiovert 100 Microscope

 

 

User’s Name: ____________________________________________________________                                                                                                              

Tel : _______________________  E-mail: _______________________________

 

P.I.’s Name: _____________________________________________________________                                                                                    

Tel : _______________________  E-mail: _______________________________

 

Campus Address: _________________________________________________________

 

Account  (Check one):               Hourly (Assisted)  ___   Hourly (Unassisted)  ___                                                             

 

PO Number: _________________________            Date: _________________________

 

Billing Address: __________________________________________________________

 

Project Name: ____________________________________________________________                                                                                                                               

 

Specify fluorophores: ______________________________________________________

 

Experience with Fluorescence Microscope: _____________________________________

 

________________________________________________________________________

 

________________________________________________________________________

 

Please print, complete and mail to:

 

Noriko Kane-Goldsmith

Neuroscience Imaging Facility

W.M.Keck Center for Collaborative Neuroscience

Dept. of Cell Biology and Neuroscience

D251

604 Allison Rd. Piscataway, NJ 08854

Phone: (732) 445-2061, ext.40110

Fax: (732) 445-2063

E-mail: noriko@rci.rutgers.edu

URL: http://spine.rutgers.edu/if