Genotyping Contact Request Form

* Required field

First Name

*

Last Name

*

Name of Institution

*

Telephone

*

Email

*

City

*

Country/Region

*

Select CanadaUnited States

Type of Institution

*

Biobank

 Biobank

Pharmaceutical Company

 Pharmaceutical Company

Direct to Consumer (DTC) Company

 Direct to Consumer (DTC) Company

University/College

 University/College

Other

 Other

When do you plan to start your next genotyping project?

*

1-6 months

 1-6 months

6 months-1 year

 6 months-1 year

1 year or more

 1 year or more

Not planning to start any

 Not planning to start any

If you plan to start a genotyping project, how many markers are you looking at?

*

<200

 <200

200-5000

 200-5000

>5000

 >5000

Not applicable

 Not applicable