About ARIAD
Research & Development
Patients & Caregivers
Investors & News
Regulation Kits
Careers
home | contact | site map   search

Request Kits

Create User Profile

Thank you for your interest in our Regulation Kits. To request a Regulation Kit, please enter the information requested to create a user profile. Once this form is completed, you may generate a Material Transfer Agreement (MTA) and order Regulation Kits.

The Regulation Kits you request will be shipped upon receipt of a properly signed MTA. All subsequent requests for Regulation Kits and additional compounds, as well as all other correspondence with us, will require that you login to the user profile from which the approved MTA was generated. Therefore, you should only set up one user profile and keep track of your username and password. Multiple users from the same lab must share a single profile (i.e. one user profile per MTA).

All information entered through your user profile will be kept confidential.

Requester
First Name*:     Last Name:*
Title: 
Position:* Graduate Student Post-doc Visiting Fellow
  Lab Head Other
Institution:*
Department: 
Address:*
Address: 
City:*
State:* 
   Zip: 
Country:*
E-mail*: 
Phone*: 
Facsimile: 
Are you or the lab head affiliated with the Howard Hughes Medical Institute?:      Yes No
 
Do you plan to use the Regulation Kit(s) with human embryonic stem cells from WiCell (WARF)?:      Yes No
 
Would you like to receive general updates on ARIAD (i.e. press releases by e-mail)?:       Yes No
Lab Head
(if you checked Lab Head above, there is no need to fill out the boxes below)
First Name*:     Last Name:*
Title: 
E-mail:*

Choose a username and password

On subsequent visits you will need to login with your username and new password to access this page.
Please enter a username:*
(minimum 4 characters)
Please enter a password:*
(minimum 6 characters,
one of which must be a number)
Please retype your password:*
  
Email Page  Print Page
©2008 ARIAD Pharmaceuticals, Inc.
Terms and Conditions   Privacy Policy   Safe Harbor   Map & Directions