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Childhood Cancer Repository

If requesting low Oxygen condition please add your request on the special request box (Last box in the form).

Shipping and Contact Information

Please enter your name:

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Please provide the name of your courier (eg. FedEx, Airborne, World Courier) if available:
(We cannot ship via UPS or DHL at this time. Please contact us with questions or concerns.)

Please provide your FedEx or other courier account number (if available):

If you are requesting 5-15 cell lines, upload a < 1 page description of research and justification for the lines.

(PDF format only; maximum allowed file size is 2 megabytes)

If you are requesting more than 10 lines, upload a full COG biology specimen application form.

(PDF format only; maximum allowed file size is 2 megabytes)

Upload your COG Specimen Transfer Agreement:

(PDF format only; maximum allowed file size is 2 megabytes)

You can also FAX this form to 806-743-2691 if you have difficulty uploading it.

Do you have any special requests or comments? If so, please enter them here.