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Salutation:

First name:

Last name:

Title:

Department:

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Organization Address

Street Address 1:

Street Address 2:

City:

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Sample Details

Species:

Other Species:

Sample Type:

Tail tissue, approximately 0.5cm in length
Ear samples (preferred for rats)

Assay:

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Now

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Parental Genotype:

Sex:

MaleFemaleBoth

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