Cabecera

Request of Service Microscopy in Biomedicine

Request form

(*)Mandatory fields to complete.

 

 

Requester data

 

Requester data
Name(*): Surnames(*):
Phone/extension(*): e-mail(*):

 

Number of samples(*):

 

POST SAMPLE TREATMENT

 

  I wish to recover the sample after its analisis.


We reminds users of the Service that the samples should be collected after delivery and notification of the report. If the samples are not collected they will be removed for disposal in 6 months. If the user want to retrieve the samples, must notify the Service to collect them before the expiration of the deadline.

 

 

Sample data

 

Sample name(*)

Dangerous or polluting(*)

 No Yes Characterization:

Short description of the sample (*)
 

 

Sample preparation

Negative staining
Metallic coating
Drying to the critical point

 

Equipment use

Does he need technical assistance? Yes No
Transmission electronic microscope:
Scanning electron microscope:
Confocal microscope:
Flow cytometry:
Others (specify)

 

 

Experiment short description:(*)

 

You can attach multiple documents with the sample information:

 

Billing data

 

UPV/EHU user External user

 

Department(*):
Main researcher(*):
Project title(*):
Financing organism(*):
If you want the principal investigator or project manager to receive a copy of this application, you can specify his email here. Main researcher e-mail:

Research group(*):


Organic(*):

Functional(*): 21 24 25 26 others
I Know and accept the access protocol and the rate applied for services, depending on current rates or budget accepted.

 

In accordance with Article 5 of Law 15/1999 of 13 December on the Protection of Personal Data, we inform you that your data becomes part of the file "Research Management"in the UPV Country, whose purpose is the administration of Vice President for Research at the UPV / EHU. We inform you that you can exercise your rights of access, rectification, cancellation and opposition of their data by sending a letter to the person in charge of security LOPD UPV / EHU, Rector, Barrio Sarriena s / n, 48940 Leioa, Bizkaia, enclosing a copy of document proving their identity. You can view the "Regulations of the UPV / EHU for the Protection of Personal Data" in Internet addresses www.ehu.es/babestu.