Demande de collaboration

To submit a request for collaboration, complete this form and click on "Envoyer votre demande".

Person in charge of the project

Institution

First name

Name

Company Name

Molecule requested / Needs : Yes No

If yes, quantity ?

Therapeutic Area

Project name

Roche / Institut Roche contact (if applicable)

Phone

E-mail

Address

Budget requested : Yes No

If yes, quantity ?

Type of material used : In Vitro (eg. Cell lines, etc...) In Vivo Clinical samples (tumors bank)