MIC User Registration Form

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Please use this form to get started imaging at the MIC. For information on training, please go to: http://imaging.berkeley.edu/training.html.

Email *

First Name *

Last Name *

Email Address *

(Preferably berkeley.edu address if you have one)

Affiliation *

(please list your company if you are from an outside company)

UC Berkeley

LBNL

UCSF

UC Davis

Other:

Department *

Department at UC Berkeley OR list your Company or Affiliation if Non-UCB

Lab/PI *

PI Email *

Please input your PI email or for non-UCB, please input your financial contact

Location (Building Name and Room Number) *

or non-campus address if non-UCB

Position *

Graduate Student

Postdoc

Faculty

Staff

Undergraduate

Other:

Do you need any accommodation during either training or use of instruments at the facility? (you can elaborate in next question)

Yes

Maybe

Clear selection

What accommodations or innovations would help you to use our facility? Would you like to tour our space prior to training?

Clear form

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This form was created inside of UC Berkeley.