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Conference Room Reservation Form

Use this form to request a Department of Medicine conference room for a meeting or event. You will receive a confirmation within 24hours of your request. Reservations are subject to availability and may not be reserved by telephone.

Note: Remember to include time for set-up and clean-up in your request. There will be an administrative charge of $100.00 should room not be retuned in adequate condition upon review by a Department of Medicine representative.

Person making request
Division
Telephone
E-mail

Person responsible for event
Telephone
E-mail

Date of event , (mm/dd)
Recurring Event One-Time
Weekly
Monthly
Until   
Note: Remember to include time for set-up and clean-up in your request.
Start time
End time
Event Title
Number of participants
AV requirements lap top connectivity/screen
microphone
overhead projector
computer
Room selection Richard-Cournand Library: up to 12 attendees
Kimberg Conference Room: 13-30 attendees
Atchly-Loeb Conference Room: 31-55 attendees
(Conference rooms should be selected based on the number of attendees.)
Account number
(By indicating account number I authorize administrative direct charge of $100.00 should conference room not be returned in adequate condition upon sign out review by Department of Medicine representative.)

      

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Last updated 1/24/05


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