Request No:
The University of Hong Kong
Department of Pathology
Request Form for Flow Cytometry Services
(for Departmental users)
Name of the investigator: ______
Request date: ______
Operation date: ______
Sample details (Please tick if appropriate):
Sample source: rHuman rAnimal rOthers
Details (if possible): ______
Biohazard: rYes rNo
Mode of operation: rAnalysis rSorting rPC usage
If sorting needed, please fill in the following:
Sample size: ______million cells total (Estimated)
Estimated target cell population: ______%
Amount of sorted cell needed: ______million cells (Estimated)
Sorting priority: r Purity
r Purity /yield equally
r Yield
Charges:
A. Analysis HK$50 per hour
B. Sorting HK$100 per hour or HK$400 per day (8 hours)
(Timing for application A and B is based on the counter of the laser)
Duration for analysis
From ______to ______, balance =______hours x $50
Duration for sorting
From ______to ______, balance =r______hours x $100
=r1 day x $400
Total: HK$______
______
Investigator signature Operator signature
______
Account to be charged
For enquires, please call: Otis Ko (tel: 28554370, email: )
Cary So (tel: 28199395, email: )
The University of Hong Kong
Department of Pathology
Request Form for Flow Cytometry Services
(for HKU users)
Name of the investigator: ______(Dept. of ______)
Request date: ______
Operation date: ______
Sample details (Please tick if appropriate):
Sample source: rHuman rAnimal rOthers
Details (if possible): ______
Biohazard: rYes rNo
Mode of operation: rAnalysis rSorting rPC usage
If sorting needed, please fill in the following:
Sample size: ______million cells total (Estimated)
Estimated target cell population: ______%
Amount of sorted cell needed: ______million cells (Estimated)
Sorting priority: r Purity
r Purity /yield equally
r Yield
Charges:
A. Analysis HK$150 per hour
B. Sorting HK$300 per hour or HK$1,200 per day (8 hours)
(Timing for application A and B is based on the counter of the laser)
Duration for analysis
From ______to ______, balance =______hours x $150
Duration for sorting
From ______to ______, balance =r______hours x $300
=r1 day x $1,200
Total: HK$______
______
Investigator signature Operator signature
______
Account to be charged
For enquires, please call: Otis Ko (tel: 28554370, email: )
Cary So (tel: 28199395, email: )
The University of Hong Kong
Department of Pathology
Request Form for Flow Cytometry Services
(for Outside HKU users)
Name of the investigator: ______(______)
Request date: ______
Operation date: ______
Sample details (Please tick if appropriate):
Sample source: rHuman rAnimal rOthers
Details (if possible): ______
Biohazard: rYes rNo
Mode of operation: rAnalysis rSorting rPC usage
If sorting needed, please fill in the following:
Sample size: ______million cells total (Estimated)
Estimated target cell population: ______%
Amount of sorted cell needed: ______million cells (Estimated)
Sorting priority: r Purity
r Purity /yield equally
r Yield
Charges:
A. Analysis HK$150 per hour
B. Sorting HK$300 per hour or HK$1,200 per day (8 hours)
(Timing for application A and B is based on the counter of the laser)
Duration for analysis
From ______to ______, balance =______hours x $150
Duration for sorting
From ______to ______, balance =r______hours x $300
=r1 day x $1,200
Total: HK$______
______
Investigator signature Operator signature
______
Account to be charged
For enquires, please call: Otis Ko (tel: 28554370, email: )
Cary So (tel: 28199395, email: )
Flow request form 07/11/2003