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Level 2 Registration ApplicationAll registrations are subject to approval by BEI Resources and the National Institute of Allergy and Infectious Diseases.Instructions: Print or type information in ink to be legible. Please provide all requested information. Missing information willdelay the approval process or may result in denial of registration.First NameRegistrant InformationLast NameDepartment Building Room NumberStreet AddressCityState/Province Zip/Postal Code CountryTelephone Fax E-mailAlternate Contact InformationLast Name First Name E-mailOrganization NameDepartmentCheck type of organization: University/Education Research Foundation U.S. Government Hospital/Clinic Diagnostic LabOrganization/Institution InformationWeb Site Address Pharmaceutical/Drug Discovery Biotechnology/Life Science Contract Laboratory Industrial ManufacturingEmployer Identification Number (EIN) Food Processing/Agriculture Environmental International Government Other, explain:_____________________ If you work at a private, nonprofit organization, attach a copy of the Federal 501(c)(3) FormFirst NameBiosafety Officer or Environmental Officer Contact InformationLast NameTelephone Fax E-mailShipping AddressDepartment Building Room NumberStreet Address (PO Boxes cannot be accepted)CityState/Province Zip/Postal Code CountryTelephone Fax E-mailBilling AddressPlease verify this information with the accounts payable department for your organization.Contact Name (first & last name)Department Building Room NumberStreet Address/P.O. BoxCityState/Province Zip/Postal Code CountryTelephone Fax E-mailBEI Resourceswww.beiresources.orgDoc ID: 5391 Effective Date: 6/1/09 Revision 3.0Page 1 of 4

Level 2 Registration ApplicationATCC Account Number or Credit ReferencesATCC Account NumberPlease call BEI Customer Support at 800-359-7370 to determine yourInstitution’s ATCC account number.Credit References are only necessary if your institution does not have an ATCC account number. (Academicinstitutions only require one credit reference, US Government agencies are exempt from this requirement).Credit Reference 1Organization Name Contact Person Account NumberStreet AddressCityState/Province Zip/Postal Code CountryTelephone Fax E-mailCredit Reference 2Organization Name Contact Person Account NumberStreet AddressCityState/Province Zip/Postal Code CountryTelephone Fax E-mailAdditional Required Information Material Transfer Agreement (MTA)The MTA must be completed and signed by the registrant and countersigned by an official capable of legally binding theinstitution. The MTA can be found at http://www.beiresources.org/Register/RegistrationForms/tabid/261/Default.aspx.New registrants at institutions with Institutional MTAs on file with BEI Resources may leverage existing agreements bysubmitting the Acknowledgement of the MTA form. Please contact BEI Resources at contact@beiresources.org toconfirm whether an Institutional MTA is already in place between BEI Resources and your institution. Scope of Use of MaterialsSubmit an abstract, on your organization’s official letterhead, describing the proposed scope of work and the proposeduse of the reagent(s) within that scope. Please include, if applicable, the U.S. Government grant, cooperativeagreement or contract supporting that work. Biographical Sketch of RegistrantA brief curriculum vitae (maximum three pages) or the sketch from a recent NIH grant proposal may be submitted. Profile of Your Institution or CompanyOn your organization’s official letterhead, provide a brief description of your institution or company, including a Website address. Laboratory Facility Description and Biosafety Containment Level (BSL) of FacilityPlease provide a letter describing in detail how your lab facilities, access policies, material handling procedures andtraining practices fulfill the criteria established for biosafety level guidelines by the CDC/NIH in Biosafety inMicrobiological and Biomedical Laboratories (BMBL), 5th edition, HHS Publication # (CDC) 93-8395. U.S. Department ofHealth and Human Services, Centers for Disease Control, Washington, D.C. Government Printing Office, February 2007.This letter must be printed on your organization’s official letterhead and signed by the institution’s biosafety officer orenvironmental safety officer. Customer Acceptance of Responsibility (CAR)Registrant will also have to complete and return a signed CAR form. A copy of the CAR form can be found athttp://www.beiresources.org/Register/RegistrationForms/tabid/261/Default.aspx.BEI Resourceswww.beiresources.orgDoc ID: 5391 Effective Date: 6/1/09 Revision 3.0Page 2 of 4

Level 2 Registration ApplicationWe acknowledge that the information listed in this application and the required documents is current, complete and accurateto the best of our knowledge. We have read the BEI Resources Material Transfer Agreement and understand the terms andconditions of receiving materials from BEI Resources. We agree to assume responsibility for the payment of all shipping feesassociated with receiving materials from BEI Resources. We authorize the above listed contacts to provide credit referencesto BEI Resources as required._________________________________ ___________Registrant’s Name (print)_________________________________ ___________Registrant’s Title_________________________________________________Department Head/Program Director’s Name (Print)_________________________________________________Department Head/Program Director’s Title_________________________________ ___________ _________________________________________________Registrant’s Signature Date Department Head/Program Director’s Signature DateBEI Resources cannot accept registration documents by fax or e-mail. Please mail or courier this application with all requireddocuments to:BEI Resources10801 University Blvd.Manassas, VA 20110-2209Please allow 2-3 weeks after receipt of documents for registration review and establishment of an account. Once yourapplication is approved you will receive a package describing the services provided by BEI Resources including yourusername and password. Requests for materials cannot be considered until the registration process is complete. Thank youfor your application to BEI Resources.If you have questions about this application or related documents, contact us at contact@beiresources.org or call 800-359-7370.BEI Resourceswww.beiresources.orgDoc ID: 5391 Effective Date: 6/1/09 Revision 3.0Page 3 of 4

Level 2 Registration ApplicationAdditional Registrant AppendixBEI Resources offers institutions with multiple researchers the ability to register under one registration package. Additionalregistrants must identify themselves below and must be working in the same laboratory or for the same entity as the primaryregistrant. Each additional registrant will need to submit a Biographical Sketch, Signed CAR Form, and Scope of Use for the materialswhich they wish to receive. They must also be covered within the Laboratory Facility Description letter. The institution must submitan Institutional MTA to bind all researchers.All registrations are subject to approval by BEI Resources and the National Institute of Allergy and Infectious Diseases.Instructions: Print or type information in ink to be legible. Please provide all requested information. Missing information will delaythe approval process or may result in denial of registration.First NameAdditional Registrants Covered in ApplicationLast NameDepartment Building Room NumberStreet AddressCityState/Province Zip/Postal Code CountryTelephone Fax E-mailTitleSignature and DateAlternate Contact Name:EmailFirst NameAdditional Registrants Covered in ApplicationLast NameDepartment Building Room NumberStreet AddressCityState/Province Zip/Postal Code CountryTelephone Fax E-mailTitleSignature and DateAlternate Contact Name:EmailFirst NameAdditional Registrants Covered in ApplicationLast NameDepartment Building Room NumberStreet AddressCityState/Province Zip/Postal Code CountryTelephone Fax E-mailTitleSignature and DateAlternate Contact Name:EmailPlease allow 2-3 weeks after receipt of documents for registration review and establishment of an account. Once your application isapproved you will receive a package describing the services provided by BEI Resources including your username and password.Requests for materials cannot be considered until the registration process is complete. Thank you for your application to BEIResources.If you have questions about this application or related documents, contact us at contact@beiresources.org or call 800-359-7370.BEI Resourceswww.beiresources.orgDoc ID: 5391 Effective Date: 6/1/09 Revision 3.0Page 4 of 4