Authorization for Internal Departmental Charges for the
Biomedical Engineering (BME) Atomic Force Microscopy (AFM) Facility

                       Contact Information

Principal Investigator: ________________________________________________

Campus Address: ________________________________________________________

Phone: ____________________________  E-mail: ___________________________


                        Billing Information

Organization #: _____________________

Fund #: _____________________________

Account #: __________________________


Is this an OSURF fund?  Yes or No        If yes,

  Project #: __________________________

  Project Title: _______________________________________________________

  Project Start Date: ___________________  End Date: ___________________

Authorized Users: (print users names)

________________________________________________________________________

________________________________________________________________________

By signing this document, you are authorizing the user(s) listed 
above to accumulate equipment usage charges that will be expensed 
to your fund.  Additional users may be authorized by submitting a 
signed Management Agreement form to the BME Administrator.  This 
authorization will remain in effect for one year from the date of 
signing or until the project ending date, which ever occurs first.  
The Principal Investigator may revoke this authorization at any 
time by first notifying the user(s) that they no longer have 
permission to use the equipment, and then by notifying the Director 
of the AFM Laboratory and or the BME Administrator.

Principal Investigator (signed):________________________  Date: ________


Please return this and all other completed registration forms to:

Kirsten Gibbons, Administrator, Biomedical Engineering,
270 Bevis Hall, 1080 Carmack Rd.  Columbus, Ohio 43210
Phone: (614)292-1625, Fax: (614)292-7301, E-mail: gibbons.40@osu.edu