Request the Global Health Priority Box

Your details

Title

First and last name *

Name of principal investigator (if different from name entered above)

Institution *

Email address *

Phone number *

Street *

City *

State/province

Post code *

Country *

Please indicate the area of research. You may select more than one. *

To ensure receipt of appropriate samples, please indicate all pathogens and/or all vector target diseases. *

*This is important, as the appropriate samples will be provided based on need and compliance with terms and conditions at the bottom of the page.

Do you intend to perform your research on primary human tissue samples (e.g. blood) from healthy volunteers or patients? *

What is the source of the samples? *

Please provide a brief summary of the research you plan to conduct (less than 250 words) *

Is this a request for another copy of the Global Health Priority Box? *

Please explain why another copy is required for your research. *

Have you previously received a copy of a different MMVOpen box (Malaria Box, Pathogen Box, Pandemic Response Box, COVID Box)? *

Please indicate how you found out about the Global Health Priority Box? *

If other, please fill in the text box.

Tick this box to confirm you have read and agree to the Terms and Conditions

I agree *

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