NIMH MEG Core Facility Access Form

Please supply the following information. Fields marked with '*' are required.

Name*
Email Address*
Phone #*
Name of PI*
Institute*
Protocol #*
User Group (e.g.,
CBDB, LFMI, etc.)		*
Approx. # of Subj.
Please provide a short
(three line) summary
of your experiment,
including a list of any
special equipment
required.

Please note that Schedule access will be granted through an assigned username/password pair issued by the MEG Core Facility Administrator; the username is generally the user's last name from the Name field above.