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ID: NC The National Center for Drug Screening Compound registration form (One form per compound) Date: Institution: Fax: Address: Postcode: Provider name: E-mail: Telephone: Compound name/number : Source: □ synthetic □ natural(□ plant □ animal □ microbe □ marine) □ others: Amount: mg purity: □ 100% Appearance: □ solid □ liquid □ 95% □ 90% □ 80% □ % □ mixture solvent and/or solubility: Molecular formula: Molecular weight: Stable: □ yes □ no □ unknown □ comments: Toxic: □ yes □ no □ unknown □ comments: Structure (applicant for free screening services must disclose the structure) : Screening assay number: (see List of screening assays at the download center) Assay name: Choice of screening services: □ free □ fee for service □ collaboration For free screening services, a minimum of 10 mg compound is required. Address: 189 Guo Shou Jing Road, Zhangjiang High-tech Park, Pudong, Shanghai, China Postcode: 201203 E-mail: [email protected] Telephone number: 86-21-5080-1313-216 Hotline for services: 800-820-5131 Fax number: 86-21-5080-0721 Website: http://screen.org.cn