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PI Name:
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Institution:
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Lab Contact Name:
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Contact Phone Number:
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Contact e-mail Address:
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Samples Shipped Date:
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Total Number of Samples: (List samples on Sheet 2)
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Tissue Type(s) Submitted: (Ear punch, Tail, Other)
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Genotyping Requested: (In-Del, SSLP, Gender)
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Gene Symbol (if In-del):
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List Primer(s)/Panel to be Run:
Panel APanel BPanel CPanel D
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Special Genotyping Notes:(Ex. If different primers/panels need to be run on different samples, special conditions, etc.)
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Billing Address: (Send Invoice to:)
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Send Analysis Results to the
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Following e-mail Addresses:
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Samples Received Date:
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Genotyping Run Date(s):
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Genotyping Analysis Sent Date:
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*PLEASE E-MAIL SUBMISSION FORM TO GENOTYPING CORE AT genotyping.core@mcw.edu
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