Application to be a registered user of the Centre for Biological Chemistry
Please complete this form and return it to Helen Johnson.
Name
E-mail
Phone (lab)
Phone (mobile)
Research Group
Lab
Please indicate (a) or (b) or (c) or (d)
(a) 12 month subscription (£1000 for 12 months, rate fixed 6 October 2014)
(b) 6 month subscription (£550 for up to 6 months, rate fixed 6 October 2014)
(c) 3 month subscription (£300 for up to 3 months, rate fixed 6 October 2014)
(d) I am visiting undergraduate student (i.e. Part III, Erasmus exchange/placement, Summer Student)
Status (please tick appropriate category)
PhD year 1
PhD year 2
PhD year 3
PhD year 4
M.Phil.
Postdoctoral researcher
Visiting undergraduate student
Start date
End Date
(if known)
Visiting postgraduate student
Start date
End Date
(if known)
Other (please specify)
I agree to abide by the rules governing the use of the Centre for Biological Chemistry. These include:
 not using equipment without being formally trained
 not using equipment without booking it
 taking full responsibility for equipment being using. Any problems, untidiness or inappropriate
use is the active users responsibility
 reporting immediately any problems with instrumentation
If you are carrying out biological related experimental work, please indicate the biological risk
assessment project numbers for your group: …………
I understand that inappropriate use of the facilities will result in me being banned from using the facilities
and that my research group will be fined.
Details of account to be debited for annual membership fee
Details of account to be charged for payment of any fine incurred
Signature
Date
Signature of supervisor
Date