Bei Resources logo

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