The Brown Foundation
Institute of Molecular Medicine
for the Prevention of Human Diseases
Laboratory for Developmental Biology
EMBRYONIC STEM CELL
SERVICE REQUEST
| Investigator ____________________________ | Date __________________________________ |
| Department ____________________________ | Institution ______________________________ |
| Lab Contact ___________________________ | E-Mail ________________________________ |
| Telephone _____________________________ | Fax ___________________________________ |
| Billing Contact _________________________ | Billing Address _________________________ |
| ______________________________________ | |
| Billing Telephone _______________________ | ______________________________________ |
| ______________________________________ | |
| Billing Fax ____________________________ | ______________________________________ |
| Making: | Transfection & Selection _____ |
| Microinjection _____ | |
| Gene Name | ______________________________________ |
| IMM Abbreviated Name | ______________________________________ |
| ES Cell Line | ______________________________________ |
Fill this form out and mail with the ES cells OR
fax the form & mail or deliver the ES cells to:
Laboratory for Developmental Biology
The Brown Foundation Institute of Molecular Medicine, Suite 637B
1825 Pressler Street
Houston, TX 77030
Telephone: (713) 500-2452
Fax: (713) 500-2424
E-Mail: transgenic@uth.tmc.edu