EMMA Axenic Service Request Form


Dear Requesting Investigator,

Please use the following form to provide general information on your mouse strain. This information is used to evaluate your axenic service request.

We would like to remind you that for a successful application it is obligatory to complete every field. Please use "unknown", "not applicable" or "none" if you do not possess the information requested. Please use one form for each strain.

Click once on the Send button at the end of this form to submit your information to EMMA.

If your browser does not support forms you can e-mail all the complete strain information to EMMA.

Within 30 days you will be notified by e-mail of the result of the evaluation of your axenic service request.

Thank you for your interest in the European Mouse Mutant Archive.

Scientist's Title
Firstname
Surname
E_mail
Phone
Fax
Institution
Department
Address line 1
Address line 2
County/Province
Town
Postcode
Country
Shipping Contact's Title
Firstname
Surname
E_mail
Phone
Fax
Institution
Department
Address line 1
Address line 2
County/Province
Town
Postcode
Country

Axenic conversion of strain:


Original owner's title
Firstname
Surname
Do you have the permission to use the strains for the germ-free service? Yes
No
Your strain/line name

Description of the mutation/s and the construct/s



Is/are the mutation/s dominant/recessive ...?
Chromosomal mapping of the mutation(s) (if known)

Mutant phenotype


Are homozygous mice viable? Yes
No
Not known
Are homozygous mice fertile? Yes
No
Not known

Phenotype description



Relevant bibliographic/database references


PubMed IDs (insert the numeric ID and divide by semicolon if more than one)

Look it up in PubMed - a service of the National Library of Medicine.

Reference(s) description


Strain genetic background


On what genetic background was this strain generated?
On what genetic background is this strain currently maintained?

How is your strain characterised?


Genotyping,
Phenotyping,
Other method

Brief description of characterization procedures:
(eg.: ID and sequence of PCR primers, Southern probes, phenotyping protocol etc.)


Description of the scientific purpose of germ-free conversion



Additional information


If the submission request is accepted when could you provide 6 females and 3 males (5-12 weeks old)?


Description of breeding performance


Specific information on animal husbandry (nutrition, special handling, light cycle ...)


(Click on the "Send" button once to submit the form to EMMA.)

PLEASE NOTE:
If you want to proceed with another submission just modify the form as needed and click again on the 'Send' button once.
To reset the form please use the 'Clear all fields' button.