Expression of Interest

EXPRESSION OF INTEREST FOR MATERIAL AND/OR INFORMATION FROM BCTB
Principal Investigator (full name and title):	*
Affiliation and Full Postal Address:	*
	Post/Zip code: *
Telephone:*	Fax:
(Include international dialing code)
Email: *	Confirm Email: *


Title of research project:	*
Co-investigators (names and titles):	*
Duration of project *months

Proposed start date *of project

Brief abstract of project (not more than 200 words): (What you want to do, what biospecimens and data are required and approximately how many) NB if project requires DNA, it will be extracted by the BCTB, primary samples will not be supplied. *

Submit
Version 1 EOI Form JEC 30/07/2007
Text boxes with * sign are mandatory