fMRI User Form
Contact Information (Section 1) 

This form provides information that assists the fMRI Lab in understanding your study needs and provides us with account information for our monthly billing.  Note, email addresses listed in Section 1 will receive billing statements.
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Investigator Name (First, Last)
Department
School/College
Investigator Phone
Investigator Uniqname *
Research Assistant/Coordinator Name *
Research Assistant/Coordinator Phone
Research Assistant/Coordinator Uniqname *
Grant Admin/Billing Contact
Grant Admin/Billing Phone
Grant Admin/Billing Uniqname
If others should receive billing statements list their name(s) and unique name(s) here.
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