Plastination Laboratory Office of Medical Education

REQUEST FOR PLASTINATION SERVICES
FROM THE UNIVERSITY OF MICHIGAN

Instructions: Fill out items 1-8 below and click on Submit:

Name:
Date:
Institution:
Department:
Address:
City:
State:
Zip:
Phone:
FAX:
Email Address:
Federal Express Account #:
Recharge Account #:
Title of Project or Course:
Contact Person:
Phone:
Description and number of specimens requested:
Institution providing material to be plastinated:
Will material be used outside the facilities of the Department of Anatomy & Cell Biology?
If so, specify location of use:
Describe specimen use and storage arrangements:

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.

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For more information, contact:

Dr. Ameed Raoof
Plastination Laboratory
Office of Medical Education
The University of Michigan Medical School
3740 Medical Science II Bldg.
Ann Arbor, MI 48109-5608

Phone: (734) 615-2597 FAX: (734) 615-8191
Email: ameedr@umich.edu
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Last updated on Friday, 05-Jun-2009 12:45:58 EDT. Please send suggestions or comments to AnatomyWebmaster.