KML Facilities Use Request Form

This KML Facility Use Request Form (FURF) serves as your contract with Keys Marine Laboratory and the Florida Institute of Oceanography at University South Florida for goods and services provided. FOR CANCELLATIONS WITH LESS THAN 30 DAYS NOTICE, FULL BOOKING RESERVATION WILL BE DUE *

Agree

Today's Date *

Principal Investigator (PI) *

First

Last

Email *

Affiliation *

Co-PI or Collaborator

First

Last

Affiliation

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Contact Number *

Contact Number while on site:

How many times have you been to KML?

How did you hear about us?

Date / Time of Arrival

Date

Time

Date / Time of Departure

Date

Time

Funding Source

Other, please specify:

Grant Funded?

Federal or State Agency Name:

Other Source Name:

Billing

Other, please specify:

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Florida tax exempt? *

To 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.

If yes, please upload tax exempt form:

Click or drag a file to this area to upload.

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)

Primary Purpose for Visit

Number of undergraduates in party

Number of graduate students in party

Number of PhD students in party

Number of Postdoctoral students in party

Number of faculty in party

Number of non-faculty scientists or researchers in party

Additional number of other persons in party

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 Excel

Names of Group Members (short list):

Annual 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. *

Agree

KML FACILITY USE AND SERVICES

DORMITORY USE or DAY ACCESS? *

DORMITORY USE- Number of males in your group

Staff, students, and various groups may be sharing a room. Dorms are separated by gender preference

DORMITORY USE- Number of females in your group

Classroom Needed:

Date

Time

SEAWATER SYSTEM- Do you need wetlab and/or seawater sytem (tanks, tables, etc.) access?

If *yes*, please copy and paste this URL in your browser to access a fillable SURF: https://www.fio.usf.edu/documents/SURF-Fillable-ver2021.11.12.pdf

Drylab usage (or special project) description:

For bench space and equipment needs

PLEASE 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. *

Agree

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 STORAGE

Do you require cold storage (for chemicals and/or specimens)? *

Refrigerator space needed (cubic feet)

Freezer space needed (cubic feet)

-80C Freezer space needed (cubic feet)

BOATS

Forms required: -Boat Roster -Liability Waiver -Boating & Snorkeling Agreement

Boat Use? *

Please also fill out Boat Roster, Liability Waiver, and Snorkel Agreement if boat usage is requested

Date boat is needed

Duration of boat use

Time of day

Special Hours Requested

Vessel Preference (note: vessel choice ultimately at captains' discretion)

Number of people in group:

Will you require a vessel to be trailered off-site?

Field site locations for vessel to be trailered

Do you require dockage for your own vessel?

Length of vessel to be docked at KML

Launch details for vessel docked at KML

Please indicate how many times you intend on launching your vessel from KML docks

Do you require trailer storage?

How many days will you be storing your trailer at KML?

Additional boat needs and/or notes:

DIVING

Forms Required: -Letter of Reciprocity (LOR) from home institution -Proof of medical insurance -Dive plan -Liability Waiver

Diving? *

Do you require KML Staff Divers for project support?

Number of AAUS certified Divers

Estimated number of days diving

Estimated number of cylinders needed from KML

Number of air fills if using own cylinders

Must have VIP status

SPECIMEN COLLECTION

Do you require sampling and/or specimen collections? *

Are there permits required for your collection?

Please indicate Permit #(s), Expiration Date(s), and any other pertinent information:

Upload Current Permit(s)

Click or drag a file to this area to upload.

Is IACUC Approval (for all activities involving vertebrates) required?

Preferred collection date:

Collection methods and type(s) of species:

SHIPPING

Method of shipment:

Special packing instructions?

Shipping Account Number:

PUBLICATIONS

I hereby agree to acknowledge ‘Keys Marine Laboratory’ in any publications resulting from work conducted while utilizing KML services. Additionally, I agree to provide copies of any/all publications to KML free of charge and in a timely manner. *

Agree

DELINQUENT ACCOUNTS

Delinquent accounts may be turned over to a collection agency and all Collection Fees, including legal fees will be added to the account balance.

I understand

NOTICE OF CONSENT

I expressly consent to you, your affiliates, agents, and service providers using written, electronic, or verbal means to contact me as the law allows. This consent includes, but is not limited to, contact by manual calling methods, prerecorded or artificial voice messages, emails and/or automated telephone dialing systems. I also expressly consent to you, your affiliates, agents, and service providers contacting me by telephone at any telephone number associated with my account, currently or in the future, including wireless telephone numbers, regardless of whether I incur charges as a result. I agree that you, your affiliates, agents, and service providers may record telephone calls regarding my account in assurance of quality and/or other reasons. *

I consent

Please remember this KML Facility Use Request Form (FURF) serves as your contract with Keys Marine Laboratory (Florida Institute of Oceanography/University South Florida) for goods and services.

E-Signature: *

Use mouse/touchpad to sign

Date *

Group Roster and Demographics

KML FACILITY USE AND SERVICES

PLEASE NOTE:

COLD STORAGE

BOATS

DIVING

SPECIMEN COLLECTION

SHIPPING

PUBLICATIONS

DELINQUENT ACCOUNTS

NOTICE OF CONSENT

Please remember this KML Facility Use Request Form (FURF) serves as your contract with Keys Marine Laboratory (Florida Institute of Oceanography/University South Florida) for goods and services.

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