Stritch School of Medicine - Room Reservation Request

Name of Event
Date of Event
Number of People
Actual Event Time (specify AM or PM)	From To (do NOT include prep or cleanup time)
Who is the Audience? (Medical Students, Housestaff, Faculty, etc.)
Purpose of Room Reservation (Class, Exam, Conference, Committee Meeting, etc.)
Requesting Department or Organization
Contact Name
Contact Telephone #
Email User ID (Ex. JSMITH for John Smith)
Will Food be Served?	No Yes
Audio Visual Equipment?	No Yes, then E-mail AV Office directly with equipment requirements at SSOMAVSUPPORT@lumc.edu or leave message at x65992
Different Room Setup?	No Yes, then contact Housekeeping at x63730 AFTER your room assignment is confirmed.
Additional Information (Optional)