INTERNATIONAL REGISTRY OF WERNER SYNDROME AND OTHER
PROGEROID SYNDROMES
UNIVERSITY OF WASHINGTON, DEPARTMENT OF PATHOLOGY
BOX 357470, SEATTLE, WA 98195-7470 USA
Phone: (206) 616-4225 Fax: (206) 685-8356
BLOOD SAMPLE REQUIREMENTS
Important: Delivery time should not exceed 4 days. Contact Junko Oshima by email picard@u.washington.edu
or phone (206) 543-5088 to arrange shipment. Do not send samples before contacting us.
Collection (Sterile Techniques)
 2 or 3 EDTA (purple top) or sodium heparin tubes of blood
 Minimum of 16-20ml of blood
 Label each tube with subject’s name, date of birth and collection date
Packaging
 Ship at ambient (room) temperature or with refrigerant pack
 Ship in waterproof, Styrofoam or other insulating container
 International samples:
Include Customs Form (page 2 of this document) or mark package as follows:
Medical research, please rush
Do not freeze
Customs: Human Blood Samples for Diagnostic Purposes
Non-Infectious
No Monetary Value
EIN #916001537
Phone (206) 543-5088
 Contact laboratory for pre-addressed packages and blood collection tubes if needed
Shipment
 Federal Express or DHL will pick up blood directly from any clinic. Contact us for our third party billing
address.
 For Federal Express account and internal billing number, contact us. For DHL shipments, receipts are needed for
reimbursement.
SHIP SAMPLES PRIORITY TO:
George M. Martin, M.D.
University of Washington
Department of Pathology
1959 N.E. Pacific Street
Room K-543
Box 357470
Seattle, Washington 98195-7470
USA
Phone: (206) 543-5088
Notification
Please communicate the airbill number and date of shipment as soon as possible to Junko Oshima at her email
address: picard@u.washington.edu , fax number: 206-685-8356, or phone number: 206-543-5088 in Seattle. Collect calls
will be accepted.
Note to Customs:
Description of the Goods:
Human Blood Samples for Diagnostic Purposes
Non-Infectious
No Monetary Value
EIN #916001537
Contact: Dr. George Martin, Phone (206) 543-5088
SHIPPERS CERTIFICATION FOR NON-HAZARDOUS LIQUIDS/CHEMICALS
This is to certify that the articles/substances of this shipment are properly described by name and they are
not listed in the current edition of the IATA Dangerous Goods Regulations (DGR) Alphabetical List of Dangerous
Goods nor do they correspond to any of the hazardous classes appearing in DGR section i.e. not restricted.
Furthermore the shipper confirms that the goods are in proper condition for air transportation.
Per USDA Guidelines for Importation #1101
Procedures:
A USDA permit will not be required for the importation of material from humans and non-human
primates that: (a) are not produced in tissue culture, (b) are not actual zoonotic (affects humans and
animals) pathogens, and (c) are not potential zoonotic pathogens. In order to facilitate correct identification
of the shipment and to ensure timely delivery, USDA, AHPIS, VS recommends that the following
documentation accompany each shipment:
1. A detailed and accurate description of the material, with species identification.
The material is a human blood sample for diagnostic purposes (a diagnostic test to test for Werner syndrome at
the International Registry of Werner Syndrome in Seattle, WA)
2. A written statement confirming that the material was not obtained from humans or
non-human primates that have been inoculated with or exposed to any livestock* or poultry
disease agent exotic to the United States.
This material was not obtained from humans or non-human primates that have been inoculated with or exposed
to any livestock or poultry disease agent exotic to the United States.
3. A written statement confirming that the material is not of tissue culture origin.
This material is not of tissue culture origin.
3. A written statement confirming that the material is not zoonotic.
This material is not zoonotic.
Name and address of the Shipper:
______________________________
______________________________
______________________________
______________________________
Date:
____________
MEDICAL RESEARCH: PLEASE RUSH
Ship to:
George M. Martin, M.D.
University of Washington
Department of Pathology
1959 N.E. Pacific Street
Room K-543
Box 357470
Seattle, Washington 98195-7470
USA
Phone: (206) 543-5088