I certify that all specimens provided by the NHLBI Biologic Specimen Repository, or materials derived from said specimens, will be used for research purposes only, in my laboratory only, at this institution only, and only for the experiments proposed on this Request Form. Also, the specimens or material derived from them will not be allowed to come into the possession of any other persons except those engaged in research under my direct supervision who accept these restrictions.
 

Assumption of Shipping Costs: __________ (Initials)

I agree to assume the cost of shipping specimens by providing my FedEx (or other carrier) shipping account number, or by making arrangements for prepaid shipments. I will confirm that the carrier is certified to ship dangerous goods (biohazardous materials and dry ice) and can pick up shipments from the NHLBI Biologic Specimen Repository. No shipments will be made until my proposed shipping arrangements are accepted by the NHLBI Biologic Specimen Repository.
 

Acknowledgment of Source: __________ (Initials)

I agree to acknowledge the NHLBI Biologic Specimen Repository in all publications and presentations of studies utilizing specimens received from said Repository. I also agree to provide copies of all publications and abstracts of presentations to the appropriate branch of the National Heart, Lung, and Blood Institute.
 
 

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