Conference on Plastination
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Fill out the following submission form with the most accurate and complete information in order to request services from the University of Michigan Plastination Lab.

Name
Date
Institution
Department
Address
City
State
Zip
Phone
FAX
E-mail Address
Federal Express Account Number
Recharge Account Number
Title of Project or Course
Contact Person
Phone
Description and Number of Specimens Requested
Institution Providing Material to be Plastinated
Will the material be used outside the facilities of the Department of Anatomy & Cell Biology?
 
 
 
If so, specify location of use
Description of specimen use and storage arrangements
Send me a copy of this message
 
 
 

If my request is approved, I understand that I will be charged a fee for the preparation and use of my plastinated specimens. I will receive them on loan from The University of Michigan, will assume all responsibility for them and will use them only in the manner herein described. I agree that if any specimen is either lost or stolen, I will be financially liable for its full replacement price as detailed in the Plastination Price Schedule.