NIAID Schistosomiasis Resource Center


Schistosomes Request for Research Materials

	Name and complete mailing address
	Full Name		This form will be sent to: Dorothy McGowan PIPB, DMID, NIAID, NIH 6610 Rockledge Drive Bethesda, MD 20892-6603 email: dmcgowan@niaid.nih.gov
	Address
	City
	State
	Zip
	Phone
	Fax
	email

	Principal Investigator (Name and Address)
	Full Name
	Address
	City
	State
	Zip
	Phone
	Fax
	email

	Schistosoma haematobium	Schistosoma mansoni
	Quantity needed	Quantity needed
	Unexp. B. truncatus truncatus	Unexp. Biomphalaria glabrata
	Exp. B. truncatus truncatus/S. haematobium	Exp. B. glabrata/S. mansoni
	(annual limit - 500 Egyptian strain)	(annual limit - 3000)

	Schistosoma japoncium	Schistosome Exposed Animals
	Quantity needed	Note: Annual limit per investigator
	Unexp. Oncomelania hupensis quadrasi	100 exposed hamsters
	Exp. O.h. quadrasi/Schistosoma japonicum	250 exposed mice
	(annual limit - 500 Philippine strain)
		Quantity needed
	Unexp. O. hupensis hupensis	S. mansoni-exposed mice
	Exp. O. hupensis/S japonicum	Dose
	(annual limit - 500 Chinese strain)
		S. mansoni-exposed hamsters
		Dose

		S. haematobium-exposed hamsters
		Dose

		S. japonicum-exposed mice
		Dose

	Frequency of shipments

	Remarks


	Shipper Preference
	Shipper Account #

	Billing address (if different from above)
	Full Name
	Address
	City
	State
	Zip
	Phone
	Fax
	email