Lab Experience Request

Organizer Name*

First Last

Organizer Email*

Enter Email Confirm Email

Organizer Phone*

School Name*

School District*

School Phone*

School Address*

Street Address Address Line 2 City State ZIP Code

Billing Contact*

Is the the billing contact information the same as the organizer information you provided on Page 1?

Yes

No

Billing Contact

First Last

Email

Enter Email Confirm Email

Phone

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Billing Options*

Please select your preferred billing method:

Invoice

Purchase Order

Payment Method*

Please select your preferred payment method:

Credit Card/pCard

Check

Biotility Cancellation / Change Policy*

I have read, and understand, the Biotility cancellation policy below.

Biotility requires a 14 business day notice of changes in the number of students, or cancellations of Lab Experiences. Changes can be emailed to biotility@research.ufl.edu. Refunds or invoice adjustments for cancellations or for students that do not attend the event cannot be issued without this prior notification due to our ordering and preparation for the laboratory experiences. Any group that arrives more than 30 minutes past this start time risk their Lab Experience being cancelled. Teachers who change their Lab Experience date or cancel with less than 2-weeks’ prior notice might not be permitted to reschedule, and will be charged a $100 fee. If the number of attending students increases by more than two, please notify Biotility immediately.