AOAC RESEARCH INSTITUTE CONSULTING SERVICE - TESTING PROTOCOL DEVELOPMENT

APPLICATION FOR RESEARCH INSTITUTE PROTOCOL DEVELOPMENT
PART I - AUTHORIZED METHOD SUBMITTER

CONTACT INFORMATION
Please note that this application must be completed and submitted by the contact that is authorized by the organization to pursue and obtain validations and/or development of protocols. All correspondence in relation to this application will be directed to the contact listed in this section.

FORM NOT APPLICABLE FOR OMA
First Name*
Last Name*
Organization*
Title*
Address*
Include City/Town, State/Country & Postal Code*
Email Address*
Telephone*
LEGAL NAME OF METHOD and PTM number (if applicable):*
Date Submitted

MonthDayYear
Date

PART I.A. - FINANCIAL CONTACT INFORMATION
Please provide the contact information for the person within your organization that will be responsible for receiving and processing the payments for invoicing.
Financial Contact: First Name*
Financial Contact: Last Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number:

PART II - TERMS & CONDITIONS
Please read all of the AOAC INTERNATIONAL Terms and Conditions ( certain items are subject to change ). Consulting Services (Validation Protocol Development & Review) AOAC INTERNATIONAL Policy Documents Use of Association Name Anti-Trust Volunteer Conflict of Interest I have read and agree to the terms and conditions.*

AcceptDecline
AOAC Research Institute Fee Schedule

AOAC Policy on Antitrust

Policy on Association Name and Logo

AOAC Volunteer Conflict of Interest

PART IV- METHOD INFORMATION
LEGAL METHOD NAME:*
Catalog Number(s) - (if applicable)
PTM Certification/OMA # (if applicable)
Method Applicability and Intended Use*
Matrices to be reviewed:*
IF this is for Modification, give a brief description of proposed Modification/Extension:
Are you currently working with an AOACRI Technical Consultant?

Sharon BrunelleMaria NelsonZerlinde JohnsonKaren SilbernagelCheryl LassiterDawn DowellDon GillilandNo technical consultant has been assigned
UPLOAD ATTACHMENTS*
**Attach Supporting Documents: REQUIRED For PTM; PACKAGE INSERT(s), USER GUIDE/INSTRUCTIONS, PREP MANUAL/SOFTWARE MANUAL, GMP-QA/QC SYNOPSIS. Additional documents; Draft protocols, method safety information, etc... (multiple files allowed and file size limit is 20 MB)*

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