Howard Hughes Medical Institute Laboratories
at the University of California, San Diego
HMMI Investigator Name
Roger Y Tsien, Ph.D.

Materials Transfer
Non-Profit Recipients

UCSD Department
Department of Pharmacology 92093-0647

Date

Recipient Investigator (please type)

Recipient Institution (please type)

Name:

Name:

Title:

Address:

Email:The material described below is being provided to Recipient Institution by DR. ROGER Y TSIEN, a Howard Hughes Medical Institute (“HHMI”)
Investigator at the University of California, San Diego (“UCSD”), for research purposes in Recipient Investigator’s laboratory only. Thematerial is experimental in nature and must be used with prudence and appropriate caution, since not all of its characteristics are known.
Any fluorescent protein(s) contained in MATERIAL may be claimed in issued patents owned or controlled by the Regents of the University ofCalifornia and/or third parties.
THE MATERIAL IS PROVIDED WITHOUT WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR ANY OTHER WARRANTY, EXPRESS OR IMPLIED. THEMATERIAL IS PROVIDED WITHOUT REPRESENTATION OR WARRANTY THAT THE USE OF THE MATERIAL WILL NOT INFRINGE ANY PATENT OR OTHER PROPRIETARY RIGHT.

It cannot be used for any commercial purpose or for work on human subjects, including diagnostic testing. Should the use of this material
result in one or more scientific publication(s) Recipient Investigator should acknowledge in the paper(s) that the material was provided by
the HHMI Investigator identified above. The material must not be distributed to laboratories of for-profit companies. The material may bedistributed to other non-profit laboratories only with the HHMI Investigator’s prior consent, and only under an agreement that prohibitsfurther transfers of the material and use of the material for commercial purposes or for work on human subjects, including diagnostic testing.
The parties agree that this Agreement may be executed by electronic copy (pdf) and/or facsimile and in two (2) or more counterparts, eachof which shall be deemed an original and all of which together shall constitute but one and the same instrument.

Description of Material Provided (List up to three (3) constructs here)

1.
2.
3.

Source (if not Tsien Lab): ________________________________________________________________RECIPIENT INVESTIGATOR

I acknowledge that I have read and understand the terms of this Agreement.
By:_______________________________________________Name:_______________________________________________

Recipient Investigator Signature

Date:___________________

Date:___________________

Date:___________________RECIPIENT INSTITUTION (if required by your institution)
AGREED:
By:_______________________________________________Name:______________________________________________________________________________________________

Title:

Authorized Official of Recipient Institution Signature

THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN DIEGO CAMPUS
APPROVED:
By:_______________________________________________

Name:_______________________________________________

Title:_______________________________________________

Signature

NOTE to Recipient Institution: After the Recipient Investigator and the Authorized Official of the Recipient Institution have signed the form,
please return the agreement as a pdf attachment by email to mta@ucsd.edu and CC: TsienLab@yahoo.com. Upon request, a fully executed
MTA will be returned by email for your files. Due to high volume wet signature originals will not be returned.

HHMI Investigators: This agreement must be signed by an authorized representative of the University of California, San Diego, before materials may besent using this form. Please arrange for an appropriate University official to sign at least this agreement.
Revised 07.29.2016