ROOM RESERVATIONS EXTERNAL REQUEST FORM

APPLICATION FOR USE OF MEDICAL SCHOOL MEETING ROOMS BY AN OUTSIDE ORGANIZATION

 
Contact Information
Name of Organization
Primary Contact
Secondary Contact
Address
City
State
Zip code
Primary Contact Telephone
Secondary Contact Telephone
Fax
EMail address *
Email MUST be connected to organization requesting space
     
Organization Information
Type of organization


Event Details *   
Event Information
Name of event, course or series
Day/date of event
Start/End time Start Time: :    End Time: :
Expected attendance
Number of rooms requested
Guest speakers
AV Equipment needed?
Will any advertising or other printed or broadcast promotion be used for this event?
(Public Affairs reserves the right to review all such material prior to dissemination.)

Will there be any admission charge for this event?
Will food and/or beverages be offered at this event?
Other Notes