Please enable JavaScript in your browser to complete this form.Today's Date *Principal Investigator (PI) *FirstLastAffiliation *Co-PI or CollaboratorFirstLastAffiliation Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePrimary Contact Number *Cell Phone Number (if different than Primary Contact Number)Email *Have you been to KML before? *Yes NoHow many times you been on-site at KML? How did you hear about us? Date / Time of ArrivalDateTimeDate / Time of DepartureDateTimeAnnual Liability Waivers required for each person coming on-site to KML. Copy of form will be furnished to PI (and Co-PI) once reservation is confirmed by KML staff. Funding SourceInstitutionalSelf-FundedNSF Other Grant Other Funding SourceOther, please specify: Grant Funded?YesNoFederal or State Agency Name: BillingBill my institutionBill me personallyOther, please specify: Billing AddressSame address as aboveBill a different addressBilling AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFlorida tax exempt? *YesNoTo claim tax exemption, you MUST provide a State of Florida Tax Exempt Certificate (DR14) and the billing address provided must match the address on the Tax Certificate. Group Roster and Demographics If you don't have group roster solidified at this time, please re-submit this form with group roster demographics when you do (prior to your arrival at KML)Education level of party members UndergraduateGraduatePost-DocPh.D.OtherNumber of undergraduates in partyNumber of graduate students in partyNumber of other students in party Research level of party membersScientist/FacultyMasters ProjectPh.D. ProjectPost Doc ProjectOther Brief Description of Project or Course Title and Number *Group Roster Upload (if group is large) Click or drag a file to this area to upload. Please upload the name, gender (optional- for housing purposes), emergency contact name/number, and professional (faculty, researcher) or student (undergraduate, graduate, post-doc) level in MS ExcelNames of Group Members (if group is small):KML FACILITY USE AND SERVICESDORMITORY USE or DAY ACCESS? *Overnight (Dorm Use)Day Access (No Dorm Use)DORMITORY USE- Number of males in your groupStaff, students, and various groups may be sharing a room. Dorms are separated by gender preferenceDORMITORY USE- Number of females in your groupClassroom Needed:DateTimeSEAWATER SYSTEM- Do you need wetlab and/or seawater sytem (tanks, tables, etc.) access? Yes (if selected, please also fill out SURF form)NoDrylab usage (or special project) description:For bench space and equipment needsPlease Note: All KML users are responsible for cleanup, dismantling, and proper disposal of any items used for their projects during their stay. Failure to do so will result in a staff time charges for cleanup and remove these items.Please list all chemicals to be used on site:All chemicals and waste must be removed and properly disposed of. There is no long-term chemical storage available. Please detail your disposal plan: COLD STORAGEDo you require cold storage (for chemicals and/or specimens)? *YesNoRefrigerator space needed (cubic feet) Freezer space needed (cubic feet) -80C Freezer space needed (cubic feet) BOATSForms required: -Boat Roster -Liability Waiver -Boating & Snorkeling AgreementBoat Use? *Yes NoPlease also fill out Boat Roster, Liability Waiver, and Snorkel Agreement if boat usage is requestedDate boat is neededDuration of boat useFull day (6 hrs)Half day (3 hrs)Time of dayAM (9:00 - Noon)PM (1:00 - 4:00)SPECIAL HOURS (specify below)Special Hours RequestedVessel Preference (note: vessel choice ultimately at captains' discretion) R/V Diodon - Island Hopper (30') R/V Opah - Parker (25') R/V Mola Mola - Parker (25')R/V Nari Nari - Parker (18') Number of people in group:Will you require a vessel to be trailered off-site? Yes NoField site locations for vessel to be trailered Do you require dockage for your own vessel?Yes NoLength of vessel to be docked at KMLLaunch details for vessel docked at KMLPlease indicate how many times you intend on launching your vessel from KML docks Do you require trailer storage? YesNoHow many days will you be storing your trailer at KML?Additional boat needs and/or notes: DIVINGForms Required: -Letter of Reciprocity (LOR) from home institution -Proof of medical insurance -Dive plan -Liability WaiverDiving? *YesNoDo you require KML Staff Divers for project support? YesNoNumber of AAUS certified DiversEstimated number of days divingEstimated number of cylinders needed from KMLNumber of air fills if using own cylinders SPECIMEN COLLECTIONSpecimen Collecting? *YesNoAre there permits required for your collection? YesNoIf yes, please indicate Permit #, Expiration Date, and any other pertinent information:Upload Current Permit Click or drag a file to this area to upload. Is IACUC Approval (for all activities involving vertebrates) required? Yes NoPreferred collection date:Collection methods and type(s) of species: SHIPPINGMethod of shipment:USPSFedExUPSPickup at KMLSpecial packing instructions?Shipping Account Number:Submit
