This form will be used by the Keys Marine Laboratory board to review requests for scientific collecting requests. Be as descriptive and thorough as possible in completing this form. The information you provide will assist us in obtaining your needed organisms and shipping them to the correct address.
Name
Affiliation

Shipping Address:
(not a PO Box)

City
State
Zip
Phone No.
Email address
Preferred date for reciept:
YOU MUST SPECIFY, A.S.A.P. IS NOT SPECIFIC!
Most convenient airport (if planning air shipments)
FedEx account #: (cannot ship without this)
OR
Brief description of project (Please describe what you hope to learn from these specimens or include the abstract from your proposal):
Permit requirements: If the harvest of the species you desire is regulated, you MUST obtain a scientific collecting permit from the State of Florida. Contact Lisa Gregg at 1-850-488-6058 or lisa.gregg@fwc.state.fl.us.
Signature (type name):
Title:
Special instructions (special collecting, holding or shipping needs):
Request date:
Bill my institution
Bill me personally
Other
BILLING INSTRUCTIONS: You must check one and print billing address (make all checks payable to USF/FIO).
Billing address
Note: if billing address is not listed, the name/address on the first page will be used.
Permit Number (for regulated species)
Tax certificate #
NOTE: WE MUST HAVE YOUR INSTITUTION'S TAX EXEMPT NUMBER FOR BILLING PURPOSES.
Species 1 Name:
Quantity:
Quantity:
Quantity:
Quantity:
Quantity:
Species 2 Name:
Species 3 Name:
Species 4 Name:
Species 5 Name: