Keyword Reset/ADB ID Reactivation Form

Your Name: _________________________________________________________

Telephone: ___________________________ Institute: ___________________

ADB ID: ________________ (3 letters – entered in field to the left of the keyword field on the Administrative Data Base System Sign-on Screen – see example below – the field in RED and underlined):

ADMINISTRATIVE DATA BASE SYSTEM ADB

SIGN-ON

INITIALS: ID: KEYWORD: CODE: NEW KEYWORD:

YOUR SIGNATURE: ___________________________________

(must be signed)

Administrative Officer’s Name: _____________________________________

(signature not required)

Administrative Officer’s Phone Number: ___________________________

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Please print out and complete entire form.

FAX to 301-480-2586

We will contact you.