[Histonet] dvaneyck IHCRG Membership Application Form

[Patsy Ruegg]

verify NSH membership please
Patsy Ruegg, HT(ASCP)QIHC
IHCtech, LLC
Fitzsimmons BioScience Park
12635 Montview Blvd. Suite 216
Aurora, CO 80010
P-720-859-4060
F-720-859-4110
wk email pruegg <@t> ihctech.net
web site www.ihctech.net <http://www.ihctech.net/> 
 

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From: webmaster <@t> neo.agsci.colostate.edu
[mailto:webmaster <@t> neo.agsci.colostate.edu] 
Sent: Wednesday, April 19, 2006 11:30 AM
To: pruegg <@t> ihctech.net
Subject: IHCRG Membership Application Form


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Last_Name: Van Eyck
First_Name: Debra
NSH_Member: Yes
Employer: WAukesha Memorial Hospital
Address: 725 American Avenue
City: Waukesha
State: WI
Zip: 53188
Province: 
Country: USA
Phone: 262-928-2112
Ext: 
Fax: 262-928-4849
Email: deb.vaneyck <@t> phci.org
Surgical_Pathology: Yes
Hematopathology: 
Orthopedic: 
Veterinary: 
Immunology: 
Plastics: 
Research: 
Paraffin: Yes
Frozen: 
Cytospins: Yes
Smears_Touch_Preps: Yes
Plastics_sample: 
Sample_Other: 
PAP: 
APAAP: 
ABC_HRP: Yes
ABC_AP: Yes
SA_HRP: Yes
SA_AP: Yes
IF: 
IHC_Other: 
ISH: 
Gels: 
PCR: 
Mol_Other: 
Automated_IHC: Yes
Company: Dako
IHC_Qualification: No
Date_Taken_Exam: 
Like_To_Take_Exam: Yes
Expected_Date: next 6 months
Need_Tissues: No
Tissue_Needed: 
Need_Reagents: No
Reagents_Needed: 
Can_Provide_Tissues: No
Tissues_Provided: 
Can_Provide_Reagents: No
Reagents_Provided: 
Form: Submit
Remote Name: 207.67.109.90
HTTP User Agent: Mozilla/4.0 (compatible; MSIE 6.0; Windows NT 5.1; SV1;
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