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Title

First Name

Last Name

Company, Institution, University

Division or department

Address

Suburb

City

Country

Province

Zip Code

Contact Number

Email Address

Financial officer's First Name

Financial officer's Last Name

Financial officer's Telephone

Financial officer's Email

VAT Number

What position do you hold in your organisation?

Who is the Principal Investigator?

Principal Investigator's Email

Is this enquiry for the purposes of a grant application or an analytical project?

How did you hear about us?

Does this research involve animal or human subjects?

Yes No

If ethics has not been granted, please explain how the matter is being dealt with.

Which technology/platform are you interested in or are intending to use?

Please provide a brief outline of the project including the key objectives to be achieved by the CPGR.

The CPGR has prepared guidelines and a template for the submission of samples. Please review the documents and ensure that your samples meet the requirements.

I have read the guidelines

Is shipping required?

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What are the preferred shipping conditions?

Are import permits required?

CPGR

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Next Generation Sequencing

RT-PCR

Microarray

Proteomics

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