Prospective Biobank User QuestionnaireCompany / Organisation Name:(Required)Applicants Name:(Required) First Last Applicants Position(Required)Applicants Email:(Required) Enter Email Confirm Email Type of organisationCommercial CompanyAcademic Group Add RemoveAnticipated duration of storageAnticipated number of samples per yearKnown infectious samplesIf yes, infectious agentGMO Class(Required)N/AHG1HG2If GMO, HSE Facility NumberListSerum/plasmaBlood for DNA/RNAPMBCsUrineTissueSalivaDNARNACells (specific source)Clinical productsOther Add RemoveAdditional information (eg volume/number of aliquots/type of container)Storage Type Freezer: -20 Freezer: -80 Freezer: -150Comments:CAPTCHACommentsThis field is for validation purposes and should be left unchanged.