To submit a new lab code, complete and submit the form below. Please note that codes may not contain numbers. The lab code should be one to five letters in length (first letter is upper case, followed by all lower case).

Desired Lab Code:


Primary Investigator:
Prefix (Dr., Mrs., etc.):


First Name:


Middle Name:


Last Name:


Suffix (PhD, DVM, MD, etc.):


Title:


Organization:


Contact Person (if different from Primary Investigator):
Contact Person First Name:


Contact Person Last Name:


Address/Phone/Fax/E-mail:
Address 1:


Address 2:


Address 3:


Address 4:


City:


State/Province:


Zip/Postal Code:


Country:


Phone:


Fax:


E-mail:


Web Site:
http://