Request for participation

Request for participation in PT Program

Please complete details for the ‘Postal Address for Invoice’ and the ‘Physical Address for Delivery of Samples'. The samples, Instructions to Participants and Results Sheet will be sent to the physical address below.

Please indicate below if you wish to obtain additional sample sets, submit additional results or have an existing Purchase Order Number.

Required *

Program Name

Postal Address for invoice:

Invoice contact first name:

Invoice contact surname:

Facility Name

Facility Address

Contact Phone:

Contact Email

Physical address for delivery of samples:

Same as above:

First Name

Surname:

Facility name for delivery:

Facility address for delivery:

Phone:

Email:

Number of additional sample sets:

Number of additional results to be sent:

Purchase order number (if required):

Comments or Questions

Agree to terms and conditions

I request that my laboratory participate in the PTA proficiency testing program indicated below. By submitting the request online, I agree to PTA’s terms and conditions as outlined in the PTA Pay/Cancel Policy available on the PTA website.

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