Human MRI Research Project Application Form - CIBM

Applicant first name

Applicant last name

Applicant’s E-mail

Applicant’s phone number

Applicant is not PI

Principal Investigator first name

Principal Investigator last name

Principal Investigator’s e-mail

PrincipaI Investigator’s phone number

PI’s Institution

PI’s Laboratory/Unit

Please select resources requested

Number of MRI hours (7T@EPFL)

Number of MRI hours (3T@BBL)

Number of MRI hours (3T@CHUV)

Number of MRI hours (3T@HUG)

Number of MRI hours (7T@CB)

Account number (if known)

Billing address of the PI

City

State/Province

Zip/Postal

Country

Agreement

I have read the facility/infrastructure access policy and guidelines and I understand the fee structure associated to this project application.

CAPTCHA