Reservation request | UMKC School of Medicine

Contact Information

Department/Organization Requesting: *

Please indicate your School of Medicine Affiliation:

Other (please explain):

Contact Name: *

First

Last

Contact E-mail: *

Contact Phone: *

Area Code

Phone Number

Event Information

Event Title: *

Brief Description: *

Please indicate the type of Event:

Please specify the Course Number (or training program, if GME):

Event Date:*

day

month

year

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): *

AM/PM

End Time (include cleanup time): *

AM/PM

Estimated Attendance: *

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: *

Yes

Other (please describe and/or include special requests):*

Room Setup Required (e.g. tables, chairs, etc.): *

Yes

(please select all that apply and describe specific needs below, i.e. # of extra tables, chairs, etc.)

Additional Table(s)

Additional Chair(s)

Other

Please describe Room Setup needs: *

Will your Event have food: *

Yes

Has or will money be collected at your Event (e.g. fees, dues, etc.), as 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.) : *

Yes

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.

Human Verification: