Booking form for researchers Apply for space at Kristineberg Marine Research Station – PhD students, researchers and other users Please fill in your aplication for access and resources at Kristineberg. The more accurate information you give, the better we can provide the resources you need. Boxes with an asterisk (*) are mandatory to fill in. Personal information Given name and family name * Postal address Phone E-mail address * Are more persons included in this request? Yes – enter names, phone numbers and e-mail addresses No Information about additional persons * Please enter names, phone numbers and e-mail addresses Employer information University/company etc. * Department * Address Phone (work) Invoice address * Invoice address Beställar-ID or other reference * VAT number * Work information Day of arrival * Day of departure * Research contact at Kristineberg, (if any) Project title * Project title Funding (mandatory only for applicants from University of Gothenburg) Core funding (=Funds from the Ministry of Education and Research to research and education at the department.) Grant-financed (=The project is initiated by a researcher, who sends an application to a financier, for instance a governmental research council. Funds are given to the university without additional requirements. The results of a grant-financed project do not belong to the granting agency.) Commissioned research & development (=The project is initiated by a commissioning agent. It means that a service or product is bought from the university and that the results are owned by the commissioning agent.) Name of the financier Name of the financier Brief description of the project (Abstract) * Brief description of the project (Abstract) Work plan * Work plan Species included in the project * Species included in the project * Are experiments on vertebrates or cephalopods included? Yes (include authorization from the ethical committee on animal experiments) No Do not know, supplemented later Include authorization from the ethical committee on animal experiments * Include authorization from the ethical committee on animal experiments Are work with alien species and/or alien populations included? Yes No Do not know, supplemented later Specify species and/or population * Are work with radioactive substances included? Yes, special permit is required (specify isotope and activity in MBq) No Do not know, supplemented later Specify isotope and activity in MBq * Are work with other hazardous substances requiring labelling included? Yes No Do not know, supplemented later Specify substance * Are microbial work and/or work with GMO (genetic modified organisms) included? Yes No Do not know, supplemented later Please specify * Need for resources Desk space (offered only for longer stays) Yes No Do not know, supplemented later Laboratory space Yes No Do not know, supplemented later Specify type and space in m2 * Space in thermoregulated rooms Yes No Do not know, supplemented later Specify temperatures, if you want to regulate water, air temperature, or both. Specify if you want to use deep, surface water, or both. And how much space you need (m2). * Other space for aquarium tanks Yes No Do not know, supplemented later Specify m2 * Need of special instruments Yes No Do not know, supplemented later Please specify2 * Other need for laboratory resources Yes No Do not know, supplemented later Please specify3 * Does the task require diving? Yes No Do not know, supplemented later Specify diving competence qualification * Need of research vessel Alice Yes No Do not know, supplemented later Specify number of hours * Small boat Yes No Do not know, supplemented later Specify number of hours2 * Meals Yes No Do not know, supplemented later Specify any requests for special diets * Accommodation Yes No Do not know, supplemented later Other special requirements I accept that my name will be visable in the list of visitors in the stations lobby during my visit. Consent for storing submitted data * Yes, I give permission to store and process my data Submit Contact Booking, KristinebergPhone: +46 31 786 95 00booking.kmf@polar.se
