Room Reservations

Reservation request


Contact Information

Department/Organization Requesting: *
Please indicate your School of Medicine Affiliation: *
Other (please explain): *
Contact Name: *
Contact E-mail: *
Contact Phone: *
-

Event Information

Event Title: *
Brief Description: *
Please indicate the type of Event: *
Please specify the Course Number (or training program, if GME): *
Event Date:*
 / 
 / 

Note: If event contains recurring dates or requires multiple days (i.e. classes, conferences, training, etc.), select only the start date and include the additional date/time details in
Other Event Information (last section of form).

Start Time (include set up time): *
 : 
End Time (include cleanup time): *
 : 
Estimated Attendance: *
Intended Audience (please select all that apply): *
Other (please describe): *

Preferences

Note: Room preference is not guaranteed, but will be considered.
Rooms are assigned based on need (size, A/V, etc.).
Please see Policy No. 23 (PDF) for more information.

Preferred Room:
Second Choice:
Audio/Visual Services Required: *
(please select all that apply) *
Other (please describe and/or include special requests):*
Room Setup Required (e.g. tables, chairs, etc.): *
(please select all that apply and describe specific needs below, i.e. # of extra tables, chairs, etc.) *
Please describe Room Setup needs: *
Will your Event have food: *
Will money be collected at your Event (e.g. fees, dues, etc.), OR was/will be collected as any form of admission OR as a requirement, for a person attending this Event, in order to receive any type of credit or training/instruction (e.g. Continuing Education, etc.) : *
Please explain: *

Other Event Information

Please use the space below to provide any additional information or specials needs to assist in making this a successful event:

After submitting the request, a confirmation email will immediately be sent to the Contact Email specified above. There is no other confirmation action on this page.