2016 REGISTERED USER REQUEST FORM
BOSCH INSTITUTE
BOSCH MASS SPECTROMETRY FACILITY
(BMSF)
REGISTERED USERS ARE DEFINED AS THOSE PEOPLE WHO HAVE COMPLETED THIS REGISTRATION FORM AND AGREED TO
PAY THE FULL ACCESS FEE. A REGISTRATION FORM AND ACCESS FEE MUST BE COMPLETED FOR EACH USER OF THE BMSF
INDEPENDENTLY FOR EACH CALENDAR YEAR. THOSE PEOPLE INCLUDED IN SCHOOL OF MEDICAL SCIENCES (SOMS) WILL
BE ELIGIBLE FOR SOMS RATE OF $418 PER ANNUM. THERE IS NO CAP PAYMENT FOR MULTIPLE LAB MEMBERS. OTHER
MEMBERS OF THE UNIVERSITY OF SYDNEY (NON-SOMS MEMBERS) WILL PAY AN ACCESS FEE OF $595. ALL OTHERS MUST
PAY THE EXTERNAL USER FEE OF $1500.
NOTE: ALL REGISTERED USERS MUST UNDERTAKE APPROPRIATE TRAINING BEFORE USING THE FACILITY – DETAILS CAN
BE OBTAINED FROM THE CORE FACILITY OFFICER. IN THE EVENT THAT SOMEONE IS FOUND TO HAVE MISUSED THE
FACILITY, ACCESS MAY BE WITHDRAWN.
Parties to this Agreement
Registration Details (Please Print)
Title: _____ Surname: ___________________________ Given Name: ______________________________
Staff/Student ID:__________________
Position:
__________________________________________
SoMS Research Laboratory: _______________________________________________________________
[Note only those listed on the Directory of SoMS will be counted as SoMS Members for the purpose of determining Access
Fees]
Or External Address: ______________________________________________________________________
Contact No: ____________________
Email: _______________________________________________
Duration of access: ________________ to 31 December 2016
Name of Supervisor: ________________________________________________________________
Have you completed the Training Requirements?
Date Training Completed:
_____________
 Yes  No (Please tick))
Details: _______________________________________
Annual Fee for SoMS Member is $418 per Core Facility
Annual Fee for Member of the University of Sydney is $595 per Core Facility
Annual Fee for Non University of Sydney is $1500 per Core Facility
Fees run for Calendar Year.
Access Fee Payment - Journal Transfer (Please print details)
I __________________________________ from the Discipline of ___________________________________
_________________________________________________________________________________________
Endorse the journal transfer of from my account code:
Amount:
$418
$595
Class: 5414
RC: __ __ __ __ __
$1500 (Please tick)
Project: __ __ __ __ __ Analysis: __ __ __ __ __ __ __ __
Being 2016 Access Fee for the Bosch Mass Spectrometry Facility for:
Registered User:
_______________________________________________________________________
Signed (Supervisor, HOD etc): _______________________________________Date:_________________
To be completed by the BMSF Officer:
Date Sent to Accounts:
________________
Date Completed:
_________________
Project Brief Description (Optional)
________________________________________________________________________________
________________________________________________________________________________
What are your samples in (water, plasma, buffer etc): ____________________________________
________________________________________________________________________________
Which equipment do you wish to use:
(Please tick)
 QQQ LC/MS
 Single Q LC/MS
 ImagePrep
 General equipment
 HPLC-EC/UV/FL
 Biological safety cabinet
 CO2 incubator
 Shaking water bath
 Tissue homogeniser
 Dry block heater and evaporator
 Drying oven (5-200˚C)
 Workstation for MALDI-imaging
 Inverted microscope
 Freeze dryer
 Vacuum extraction manifold
 Refrigerated centrifuge
 Evaporator plus
 37˚C drying oven
 Sonicating water bath
Any other relevant information: ________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Conditions of Use
1. The Registered User will have access to the Bosch Mass Spectrometry Facility in the Medical
Foundation Building.
2. The Registered User must undertake appropriate training with the BMSF Officer prior to using
specialised equipment and/or areas.
3. The Registered User must at all times follow all rules and procedures for the use of the facility
including the wearing of any required safety clothing, if appropriate.
4. The Registered User will be responsible for the general maintenance and cleanliness of the
equipment and areas being used including the safe disposal of any waste materials.
5. The Registered User must report any accidents or misuse of the Facility to Dr Xiaosuo Wang on
(Lab) 9036 3060, (office) 9036 3460 or (Mobile) 0423 335 188.
6. The Registered User must NOT allow access to non-registered users.
7. Prior to the commencement of access, the Registered Users must have completed and have a
delegated authorised signature on the Access Fee Payment – Journal Transfer Form.
8. In the event that you breach any of the obligations under this Agreement, the Bosch Institute is
entitled to terminate this agreement without notice.
9. This Bosch Core Facility should be acknowledged on all publications and presentations resulting
from its use, and, if appropriate, the Core Officer should also be acknowledged. The text is as
follows: The authors acknowledge the support received from the Bosch Institute's Mass
Spectrometry Facility, and the expert help of Facility staff, especially insert
name/s........
10.When the core officer is involved in method setup and development, the service is
either fee based or through a prior collaborative authorship agreement.
Agreement
Agreement
I agree to the above terms and conditions.
Name __________________________________________________________
Signed _______________________________________ Date _____________
Thank You