PRIMARY AIRWAY CELL REQUEST FORM
NAME: ______________________________________________ DATE: _____________________________
FUNDING SOURCE (NIH, CFF, Department, Other): ____________________________________
CONTACT PHONE: _______________________
Oracle Account# ______________________________
CONTACT EMAIL: _____________________________________
CF RELATED PROJECT?
YES
NO
Tissue Source Desired:
(check all that apply)
Sinus
Phenotype Desired:
(check all that apply)
_______CF
∆F508/∆F508
Premature Termination Codon
Any genotype (includes
same unknown)
Other _______________
_WT____
_CF_____
Passage Request (check all that apply):
P0
P1
Confluency ( for non-polarized)
IF NO, GENERAL TOPIC______________
Lung
P2
WT_____
CF______
Non-CF____
COPD
IPF
Any
Other ______________
Any Passage
FORMAT
POLARIZED
# ITEMS REQUESTED
NON-POLARIZED
# ITEMS REQUESTED
Snapwell (6/plate)
WT_________
CF__________
24mm plastic (6/plate)
WT________
CF_________
6mm Transwell (12/plate)
WT_________
CF__________
T25 Flask
Cover slips (specify a coating)
WT________
CF___ _____
12 mm Transwell (12/plate)
WT_________
CF__________
Other___________________
WT_________
CF__________
Other _______________
WT________
CF________
Submit to Marina Mazur at MCLM 799 when completed or e-mail maz@uab.edu
NOTE: Effective 05/01/12, the UAB Cystic Fibrosis Research Center Clinical and Translational Core will be charging a
nominal fee for Human Bronchial Epithelial cell cultures obtained from our laboratory for non-CF research. Each 12 well
tray of primary airway cells will be billed at $200/tray to cover our costs. Place your order by emailing this form to
maz@uab.edu and the Oracle account number to be charged.