Difference: AffiliateEndorsement061130110206 (15 vs. 16)

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META TOPICPARENT name="DavidStokes"

AFFILIATION ENDORSEMENT AT NYSBC

Your notes

Please change this text to indicate any additional information not reflected on the form below

  • ENDORSER -- Your name will automatically appear as the creator of the new endorsement. You will shortly receive an email copy of the confirmation of the affiliation. If you have not received it in two working days, please email dcadmin@nysbc.org noting the affiliate's name. You may wish to print this page for your records.

Endorsement must be made by members of the Scientific Committee at NYSBC or by staff supervisors at NYSBC. Misrepresentation of the endorser will be regarded extremely seriously.

Your endorsement includes your understanding that ... The endorser will immediately inform NYSBC when the affiliate nominee is no longer associated with them. The endorser understands that the affiliate’s use of equipment and activities are subject to NYSBC’s General Operating Handbook including “E.4 Disputes as to damages, accidents, and incidents will be handled by the Safety committee as outlined in other regulations.” The endorser will inform the affiliate of this. The affiliate nominee is 18 years of age or older; is a full-time employee or full-time student at this institution; is not subject to any restriction of eligibility for any contracting or subcontracting with any agency of the United States Government or New York State, and from eligibility or involvement in non procurement programs of the United States Government referred to as 'covered transactions' as defined in HHS' implementation of OMB Guidelines to Agencies on Government-wide Debarment; and has filed the institutional Conflict of Interest form for any Federally supported activity. The project(s) involved are predominantly scientific research in the public interest within the meaning of section 501(c)(3), and less than 5% of the activity will be “unrelated business" or commercial research . The project conforms to all institutional and NYSBC regulations. These affiliation conditions may change, and the current version is available at AffiliationConditions.

Template is AffiliateTemplate, created by DavidCowburn Jan 2006

NYSBC OFFICE USE ONLY -- ENDORSER DONT CHANGE THIS Notes for staff ENTRY
ID NUMBER IN DATABASE , > 10000 indicates ID CARD # and infotech status 12663
EMAILED COPY OF DATABASE INFO ETC TO ENDORSER, APPROPRIATE MANAGERS, INFOTECH ON Done
ALL HOURS STATUS STEPS C14 Cert # 82916057 Exp 6 Mar 2010 NYSBC All hours training Complete AllHours
Original ID
11972
META FORM name="AffiliationRequestForm"
FORM FIELD New Affiliate NewAffiliate Martin Vink
FORM FIELD Affiliate Status AffiliateStatus Staff NYSBC
FORM FIELD Expiration Date ExpirationDate 31 Dec 2010
FORM FIELD Phone Number PhoneNumber 212-939-0660
FORM FIELD Affiliate Email AffiliateEmail mailto:martin_vink@hotmail.com
FORM FIELD Affiliate PI AffiliatePI David Stokes
FORM FIELD Requested Access RequestedAccess Basic EM:, NysbcAccess#All_Hours_Use:, Cryo EM training:
FORM FIELD Affiliation Web Page optional AffiliationWebPageoptional?
FORM FIELD Affiliation Comment optional AffiliationCommentoptional Returned to NYSBC
META FILEATTACHMENT attachment="vinkC14.JPG" attr="" comment="" date="1181921652" name="vinkC14.JPG" path="vinkC14.JPG" size="314489" stream="vinkC14.JPG" user="Main.JasperShahn" version="1"
 
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