SCIBLU Genomics, applied biosystems(former Affymetrix)

Registration Form – DNA analysis

Please read all information at the SCIBLU Genomics webpage before completing and signing this form.

1. Project number (filled in by the microarray centre):

2. Contact name:

3. Department:

4. E-mail address:

5. LUCAT-ID:

6. Telephone no:

7. For projects paid by LU-account numbers:

LU Is your group supported by ALF?(This info is only needed for statistics)

Note: If ALF-money will pay for this study, please register below as a SUS-customer.

LU Ekonomiadministratör, e-mail:

LU Kostnadsställe, 6 digits:

LU LUCAT-ID, recipient of invoice in LUPIN:

8. For projects paid by a RS-id account numbers/ALF

SUS Organisation no, 10 digits:

SUS Invoice ref:

SUS Invoice address:

SUS Invoice address, add from list:

9. For external projects; all projects outside LU/SUS

External Organisation no, 10 digits:

External Invoice ref:

External Invoice address:

non-Swedish VAT no:

10:Principal investigator:

11. Number of samples:

12. Species:

13. Sample origin (blood, tissue, cells, etc):

14. Array type:

15. Do you consider your material non-contagious/non-hazardous?

16. Expected sample delivery date:

17. Concentration & OD measurement data of DNA (max 1 month old) submitted:

18. Wish bioinformatic evaluation of array data? Yes/No:

If yes, has your project setup been approved of (mandatory!) by Fredrik Levander?

19. Wish to compare this project to previous data, Yes/No:If yes, please contact Fredrik Levander.

20. Wish remaining DNA back. (It is customer’s responsibility to pick it up within 1 month):

Data will be delivered in LU-Box

Any remaining samples must be picked up within a month, or it will be thrown out.

For LU-customers overhead is not included in the price. For SUS and all other non-LU customers overhead will be added to the preparation and bioinformatics cost.

The customer accepts that the SCIBLU Genomics is in charge of making all necessary quality judgements throughout the experiment.

Please note that any remaining DNA, not picked up within a month, will be thrown away.

Please complete this form (3 pages), sign and return it via e-mail to Ingrid M. Rading when samples are ready to be delivered.

As a principal investigator on this project, I agree to this order and accept the conditions stated in this Registration Form and in the SCIBLU Genomics webpage.

Note: I also acknowledge the use of SCIBLU Genomics at Lund University in the Acknowledgement section in any resulting publication.

Name:Date:

Sample Information Sheet

For Oncoscan: DNA concentration 12 ng/µl (Qubit or PicoGreen). Minimum 8 µl delivered in a plate.

Sample name
(don’t use / : \ ) / OD 260/280
(Nano-
Drop) / OD 260/230
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Drop / Expected deviations
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24. Pos ctrl (applied biosystems)

Contact person: Ingrid M. Rading

Delivery address: Lund University, SCIBLU Genomics, microarray unit, Immunotechnology (Byggnad 406),

Medicon Village, Byggnad 402A, Schelevägen 8, SE 223 63 Lund

Visiting address: Lund University, SCIBLU Genomics, microarray unit, Medicon Village, Byggnad 406, Scheelevägen 2, Lund

E-mail:

Phone: +46 46222 1542

URL:

Registration Form_170418_IMR