LTRC - Express Tissue Application

LTRC Express Tissue Application

First Name:

Last Name:

Please provide the address to which specimen will be sent upon application approval

Street Address

City:

Suite:

State

Zip:

Phone#:

E-Mail:

Institution:

Abstract Title:

Abstract:

(max of 500 words)

Number of specimen per group


Select up to four (4) subject groups
Disease Group	>80%	50-80%	<50%
COPD (FEV1% Predicted)
IPF (FVC% Predicted)

Select up to three (3) from the list below

Tissue	Formalin Fixed	HOPE Fixed	RNA Later	Flash Frozen	Glutaraldehyde
Blood	Plasma	Serum	DNA

A limited number of HOPE fixed broncho-vascular bundles is also available for distribution. Please contact us for details.

Click here to review Appendix IV of the LTRC Specimen Policy. To complete this application this document titled "Investigator and Institutional Certifications" must be reviewed, signed and faxed back to C-TASC at (410) 435-0689. No application will be considered until the signed fax is recieved.

A template letter explaining the purpose of the LTRC is provided to aid a researcher in obtaining expedited IRB review at their institution. Refer to the OHRP guidelines for information on human subjects research.


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