RADIOACTIVE MATERIAL REGISTRATION FORM
 1. AUTHORIZED USER INFORMATION This electronic form is to be used to notifiy the Environmental Health & Safety, Radiation Safety Program that you have placed an order for radioactive material (RAM).You must still place your order with the vendor.
First Name: Last Name:
Email Address: Phone Number:
PI:
Department:
 2. RADIOACTIVE MATERIAL INFORMATION
If you don't see an isotope listed under your PI, please contact radiation safety, you may not be authorized to order the isotope in question.
Isotope: 		 Activity mCi: 
Chemical/Phys. Form: Vendor:
Catalog Number: PO Number: 
Date Ordered: Expected Delivery Date: 
 Click Here to select date  Click Here to select date
 
Comments: