|==============================================================================|
|                        IMGT/LIGM-DB User Report Form                         |
|                                                                              |
|==============================================================================|
| Return to:                                                                   |
| Professor Marie-Paule LEFRANC                                                |
| IMGT®, the international ImMunoGeneTics information system®                  |
| Laboratoire d'ImmunoGénétique Moléculaire, LIGM                              |
| UPR CNRS 1142, Institut de Genétique Humaine                                 |
| 141 rue de la Cardonille 34396 MONTPELLIER Cedex 5                           |
| FRANCE                                                                       |
|                                                                              |	
| Telephone: +33(0)4 99 61 99 65                                               |	
| Fax      : +33(0)4 99 61 99 01                                               |
| e-mail   : Marie-Paule.Lefranc@igh.cnrs.fr                                   |
|                                                                              |
| IMGT® home page: http://www.imgt.org                                         |
|------------------------------------------------------------------------------|
| Name:                                | Address:                              |
|--------------------------------------|                                       |
| Telephone:                           |                                       |
|--------------------------------------|                                       |
| Date:                                |                                       |
|==============================================================================|
| Type of report:  [ ]error   [ ]problem   [ ]suggestion   [ ]comment          |
|------------------------------------------------------------------------------|
| Release of database to which this report applies:                            |
|------------------------------------------------------------------------------|
| Entry or entries affected:                                                   |
|------------------------------------------------------------------------------|
| Date you received the data:                                                  |
|==============================================================================|
| Report (please be as precise as possible - attach listings if necessary):    |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|                                                                              |
|         Continue on further sheets (or Xerox form) if necessary              |
|==============================================================================|
|            --------------- for staff use only ----------------               |
|                                                                              |
| Date received ______________________  | Report Number     __________________ |
| Acknowledged  ______________________  | Releases affected __________________ |
| Date resolved ______________________  | Investigator      __________________ |
|==============================================================================|