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.

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?
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. How did you hear about the Turner Designs Instrument Donation Program? Please specify:
Additional Comments


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