Transgenic Injection Request

Name:_______________________________

Date:__________________

Phone #_______________________

e-mail:_______________________

Lab: Cepko Dietrich Dymecki Tabin (circle one)

Construct name:_______________________

Construct size:________________________

Mouse background strain: B6SJL or FVB (circle one)

PI signature *:________________________________ Date:________________

*An e-mail from your PI will also suffice. Print this form and fill out all information.

This form must be submitted with your construct and other requested documentation.

E-mail to aabney@genetics.med.harvard.edu