Managed Breeding Service Agreement

MANAGED BREEDING SERVICE AGREEMENT
Whitehead Biomedical Research Building
615 Michael Street Suite G02
Atlanta, GA 30322
PRINCIPAL INVESTIGATOR
Name*
First NameLast Name
Department
Email*
Phone Number*
Area CodePhone Number
IACUC Protocol #*
Protocol Expires
MonthDayYear
1
Speedtype*
LAB CONTACT(S)
Primary Lab Contact
First NameLast Name
Phone Number
Area CodePhone Number
Weekend/Holiday Phone Number
Area CodePhone Number
Email
Other Lab Contact
First NameLast Name
Phone Number
Area CodePhone Number
Email
STRAIN INFORMATION
Full Strain Name*
Commonly Used Abbreviation
Strain Origin

GENOTYPE INFORMATION
Genotyping Samples
TransnetyxLab
Transnetyx Account E-mail
Transnetyx Password
Breeder Genotypes
Other
Desired Genotypes
homozygoushemizygousheterozygouswild typeknockoutpositiveOther

ADDITIONAL INFORMATION
Additional Services
Background strain transferTimed pregnanciesProduce only F1 hybridEstablish newly created transgenic lineParallel control colonyOther
Additional Service Instructions
Health Concerns/ Strain Related Adverse Phenotype
By submitting this form, I request DAR to manage my breeding mice in accordance with the husbandry procedures of DAR. I understand there is an additional charge for this service and that this agreement will remain in effect until I notify DAR in writing to transfer my mice out of the Managed Breeding Service.
Signature
Name
First NameLast Name
Date
MonthDayYear
2
Discontinue this strain?
END BREEDING