Animal Use Training Registration Form

Instructions:

  1. Use one form per person and fill in all required fields completely.
  2. Submit completed form to the Animal Use Training Programat . Please allow for up to 1-2 business days for processing.
  3. "Walk-ins" will not be allowed to attend classes. Late registrations cannot be accepted.

Please note:

  1. University personnel and others working on UW IACUC protocols are not charged to attend classes; however, expenses are incurred even in the registrant's absence and therefore a charge of $48.55 will be levied for persons who fail to attend a session if they have not cancelled 24 hours in advance.
  2. Non-University personnel are currently charged $68.79 to attend Mouse Lab and $85.39 to attend Rat Lab which includes an 18.6% institutional overhead fee. A re-registration fee of$57.58 will be levied for persons who fail to cancel 24 hours in advance. A purchase order number (PO #) or credit card # is required at the time of registration; include PO # below and submit a copy to r submit credit card information via the Credit Card Authorization Form(note: submit credit card form directly to rather than the address listed on the Credit Card Authorization Form. If questions, call 206-221-7709).
  3. Registration requests will beacknowledged via email. Email reminders with complete information (e.g., meeting location) will besent a few business days prior to classes.

**PLEASE TYPE – HANDWRITTEN FORMS WILL BE RETURNED**

Required for All Registrations
Name (last, first, m.i.): / Phone #:
Department: / Budget #(cannot start with 61 or 62):
PI Name (last, first, m.i.): / IACUC Protocol #:
Registrant’s Email Address:

Required for Non-UW Personnel(PO #or credit card # required as per above instructions.)

Billing Contact Name: / PO #:
Billing Contact Email, Phone, and Mailing Address:
Required for Mouse/Rat Lab Registrations(Approx. 2-3 techniques can be covered per Section B.)
Date passed mouse/rat online exam: / Techniques you need to learn:
Required for Surgery Lab Registrations
Date passed surgery online exam: / Species you are working with:
Surgery you will be performing:
Required for Facility Orientation Registrations
Date passed Annual Rodent (SPF) Training online exam(rodent users only):
Proxy Card #:
EID/SID # (for ARCF and Guthrie users only): / PIN(any 4 digits that you choose):
(for 6th fl, ARCF, Foege, HR&T,T-wing users only)
Housing room(s) you need access to: / Gender(for T-wing users only): Male Female
Class Requests, Required for All Registrations(Provide at least two alternate class dates.)
Class / Day / Date / Time / 1st, 2nd, 3rd Choice

11/16/17