Please complete all sections below and return to LGC Standards Proficiency Testing by email, fax or post.

Please tick the required sample(s) in the grid below:

Round / Despatch
Date / Reporting Deadline / Price per Round / Please tick ü
FM203 / 25 Mar / 03 May / £250.00
FM209 / 23 Sep / 01 Nov / £250.00
Round / Description / Tests Available / Presentation
FM203 / 1 - Hydrocarbon Oil / d2H; d13C; d15N; d18O / 0.5g in sealed amber vial
2 - Chitin / d2H; d13C; d15N; d18O / 0.5g in sealed amber vial
FM209 / 1 - to be confirmed / d2H; d13C; d15N; d18O / 0.5g in sealed amber vial
2 - to be confirmed / d2H; d13C; d15N; d18O / 0.5g in sealed amber vial

For details on the full technical specification of the scheme, please refer to the FIRMS Scheme Description.

Please fill in your address details below:

Send Test Materials to: / Send Invoices to:
Contact name: / Contact name:
Department: / Department:
Company: / Company:
Address: / Address:
Town/City: / Town/City:
Post/Zip Code: / Post/Zip Code:
Country: / Country:
Tel: / Tel:
Fax: / Fax:
E-mail: / E-mail:
VAT no:
Send Report Notifications to: / *An email will be sent to this address to notify when the report is available to download from PORTAL, the online reporting system
Contact name:
E-mail*:

Extra samples

For additional samples, please state clearly your requirements below. Additional and repeat samples are available at a cost of £38.00 per sample.

Please note:

·  All prices stated are exclusive of VAT and carriage.

·  VAT (charged at the prevailing rate) is payable by all participants based in the UK and by those in the rest of the European Union if a VAT Registration Number is not provided.

·  UK participants will pay carriage at a rate of £14 per round. Participants outside the UK will pay an additional fee to cover courier charges. If you would like a guide as to these charges, please contact LGC Standards Proficiency Testing.

·  All courier charges set by LGC Standards Proficiency Testing do not include local import charges, taxes (etc.), which will be covered by the participant.

·  Do not send remittance with this form, you will be invoiced subsequently after the despatch of each round.

·  No refunds will be given for failure to take part in any round of the PT scheme.

·  LGC Standards Proficiency Testing reserves the right to not send samples or the report for previous samples to any participant that has not paid their subscriptions within the terms stated on the invoice.

·  LGC Standards Proficiency Testing cannot guarantee the number of participants that will return results for any particular parameter in each round.

·  Please note that the FIRMS scheme is not currently within the scope of LGC Standards’ UKAS accreditation (certificate 0001).

·  The prices statedare for reporting results andreceiving reportselectronically via PORTAL (internet reporting). Ifalternative data entry or reporting methods are required, further charges apply. Please contact LGC Standards Proficiency Testing forthe current charges.

Signature ……………………………………… Date …………………………

LGC Standards Proficiency Testing, 1 Chamberhall Business Park, Chamberhall Green, Bury, BL9 0AP, UK.

Telephone: + 44 (0) 161 762 2500, Fax: + 44 (0) 161 762 2501

E-mail: Website: www.lgcpt.com

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