Your Name:

Your PI:

Institution:

Department:

Charging Instructions:

YCCC Member:

Yes          No

Building/Room:

Phone:

Fax:

E-mail:

Name of Targeting Construct:

Have you met with the Targeted Mutagenesis Service prior to designing your targeting construct?:

Yes  No

Would you like to arrange for such a meeting?:

Yes  No

Selection cassettes used:

Neomycin
TK
Other - Specify

Length of Homology:

5' Arm:      3' Arm:

Total length of linearized construct:

DNA Concentration:

Date DNA Submitted: