Cryopreservation Request

* = Required fields
* Strain name:
Researcher details
* First name:
* Surname:
* Email:
Phone:
Contact details

Emails will be sent to the main contact person. Alternate contact persons will be CC'ed
 Same as Researcher details
* First name:
* Surname:
* Email:
Phone:
Add alternate contact person
Animal Facility (where the strain is housed)
Are these mice housed within the
Hugh Ennor Building (ANU Bioscience Services)?		 Yes    No    Unknown   
* Name of facility:
Person responsible for packing and shipment of mice
 Same as Researcher details
* First name:
* Surname:
* Email:
* Phone:
Person responsible for genotyping confirmation

This person will need to receive a tail tip and confirm the genotype of the mice received for cryopreservation
APF Genomics Group:
 Same as Researcher details
First name:
Surname:
Address:
Email:
Phone:
*General mouse details
If you require extra samples to be taken (eg. liver or tail) it can be requested by emailing cassandra.butterworth@anu.edu.au
Room:
Mouse details
Mouse ID Generation Date of Birth
(dd/mm/yyyy) 		Genotype Coat
Colour		 Additional details




























































Additional details:
Optional Services
IVF Test (Cost is $450 +GST) Yes     No
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