Application Form to Request Beta-Galactosidase Reagent

Please complete this entire form:

Email Address:
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First Name:
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 There is a $50.00 charge for preparation of materials. Please indicate which method of payment you plan to use.

Check (payable to Stanford University, Blau Lab)
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Please complete below a one-paragraph description of the purpose of your request for the Beta-Galactosidase reagent

(Research Interest):