This form will be used by the Keys Marine Laboratory board to review requests for KML use and by the KML staff in scheduling housing, boat use, lab use, etc. Be as descriptive and thorough as possible in completing this form. The information you provide will assist us in making your use of the KML as productive as possible.
Name
Affiliation
Address
City
State
Zip
Phone No.
Fax No.
Email address
Date of arrival
Time
Date of departure
Time
Brief description of project
Toxic and other chemicals to be used on site
Funded?
Funding Source
Names of people in group
Dormitory space:
(total number of persons and gender)
**children are not allowed in the dorms**
males
(All persons, staff or student, should be included in this total if they will require a bed in our dorms. Also, separation is by gender... staff, students, & and different groups may share a room)
females
TOTAL:
Classroom (hours and dates)
Wet lab (hours and dates)
Dry lab (bench space and equiptment)
Cold storage space required?
Refrigerator (cu. ft.)
Freezer (cu. ft.)
-40 Freezer (cu. ft.)
Outside holding tanks or pens
Boat use (dates, time, number of persons)
Scuba use (contact KML for certification requirements, equipment not provided at KML)
Disposal plan
Radioisotope Use
if yes, Permit #
Plants/animals to be collected or used for experiments (a collecting permit may be required for regulated species). If a permit is required, place name the "KML staff" as authorized personnel on your permit application.
Other equipment needs
Additional information
PLEASE NOTE: ALL KML USERS ARE RESPONSIBLE FOR DISMANTLING AND PROPERLY DISPOSING OF ANY ITEMS USED FOR THEIR RESEARCH DURING THEIR STAY. FAILURE TO DO SO WILL RESULT IN A CHARGE FOR STAFF TIME TO CLEANUP AND REMOVE THESE ITEMS.
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.
(Be sure your email address is correct, or we will not be able to respond)
Tax certificate #
NOTE: WE MUST HAVE YOUR INSTITUTION'S TAX EXEMPT NUMBER FOR BILLING PURPOSES.