Laboratory Membership Application Form

Thank you for your interest in becoming a ProCura Laboratory Member.

* Indicates REQUIRED fields.

Laboratory Member Name *
Address*
Designated Contact Person (already registered as ProCura Individual Member):
Name*
Title *
Laboratory Member Web Site:
Telephone for quick contact*

The Laboratory membership team (including the responsible)*

	Name of individual ProCura members	Position
1
2
3

Each team member must apply as Individual Member.

Description of the Laboratory work to be placed in the Laboratory Member’s area of ProCura’s Website (< 1000 characters with spaces)

Research project on proteomics (optional)
Title:

Project Description (< 1000 characters with spaces)

Link(s) to ProCura Records (optional)