Membership Request • CampusOptics

Requester Info

Email Address* Required

Phone Number

First Name* Required

Last Name* Required

First Name* Required

Last Name* Required

Email address: (Name.#)* Required

College affiliation of Principal Investigator or Space Supervisor:

Department affiliation of Principal Investigator or Shop Supervisor:* Required

What building(s) will this space occupy?* Required

Room Number(s)* Required

Will this space manage any of the following assets?

None

Lasers

X-rays

Radiation Meters

Are there any other personnel needing access to this space?

First name:* Required

Last name:* Required

Email address: (Name.#)* Required

Do you need to add an additional workers?

First name (worker#2):

Last name (worker#2):

Email address: (worker#2)

Do you need to add an additional workers?

First name (worker#3):

Last name (worker#3):

Email address (worker#3):

For any additional workers please add their information below

Add files to upload as supporting documentation.