Form Attachment #4 Attachment #4 Laboratory Enrollment Form

Attachment 5

Name

Institution

Address

City, State, Country

Month, date, year

RE: Centers for Disease Control and Prevention (CDC) Susceptibility Testing of Mycobacterium tuberculosis and Non-tuberculous Mycobacteria Performance Evaluation Program

Dear Dr____

Thank you for your interest in the Susceptibility Testing of Mycobacterium tuberculosis and Non-tuberculous Mycobacteria (M. tuberculosis/NTM) Performance Evaluation Program. At this time acceptance into (or participation in) this program is limited to public health laboratories and we regret to inform you that we cannot accept your request for participation and we are unable to process your registration.

Thank you again for your interest in this important public health initiative.

Sincerely yours,

Sandra W. Neal, B.S., MT (ASCP), M.S., Project Officer

Division of Laboratory Systems, NCID, CCID

Centers for Disease Control and Prevention

1600 Clifton Rd. NE (MS-G23)

Atlanta, GA 30333