Fluorometer Donation Program

Please complete the following information to apply for the Turner Designs Instrument Donation Program.
Note: The entire application form must be completed to qualify for the program.

Applicant's Name:

First

Last

Title:

Institution:

Department:

Address: (Line 1)

Address: (Line 2)

City:

State:

ZIP/Postal Code:

Country:

Telephone:

Fax:

E-mail Address:

Website Address:

1. Which instrument are you applying for? June Awards - 1 Aquafluor and 1 Trilogy December Award - 1 Trilogy
2. Please provide a brief description of your research/project goals:
3. List the application(s) you are interested in:
4. How will a donated instrument benefit your research:
5. List your 3 most recent publications or posters, if any, in peer-reviewed journals or scientific conferences. If the publication or poster is posted on the web please provide the link as well. Publication #1 Website: Publication #2 Website: Publication #3 Website:
6. Have you submitted an applicaltion for the Turner Designs Instrument Donation Program before? Yes No
7. If so, for what instrument did you apply? On approximately what date did you apply? Date:
8. Terms and Conditions - If donation is awarded, the awardee's institution will issue payment of $1.00 (by purchase order or check) making the donated instrument the property of the institution rather than the property of the person submitting the application. - If donation is awarded, awardee will establish and maintain a link from their institution's website to the Turner Designs Donation Program webpage for no less than 3 years from the date of donation award. Link must be active and verified prior to shipment of the awarded instrument. - If donation is awarded, awardee agrees to provide Turner Designs with information regarding the use of the awarded instrument. Information provided will be included in Turner Designs' Newsletters and/or Case Studies section of Turner Designs' website. - If donation is awarded and any scientific papers or posters generated with the donated instrument, awardee agrees to reference the instrument. In addition, awardee will link the paper(s) and/or poster(s) to the Turner Designs Instrument Donation Program by following these directions. - If donation is awarded, applicant agrees not to use the instrument to develop chemical or biological weapons. - If donation is awarded, applicant agrees to return the instrument if the institution no longer needs it. Turner Designs will, in turn, donate it to another applicant.
9. How did you hear about the Turner Designs Instrument Donation Program? Please specify:
Additional Comments
By clicking submit below the applicant, named above, agrees to all terms and conditions stated in the terms and conditions portion of this application.


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