MD Program Interest Group Room Booking Request Form

Student/Group Info

Event:
Student Name/Class:
Student Email:
Purpose/Event:

Date of Event

Start Time of Event

Please be clear and specify AM or PM

End Time of Event

Please be clear and specify AM or PM

Building Preference:

Choose one of the following answers

MDCL
HSC
WRC
NRC
Other:

Number of Attendees at each site:

For any site(s) not involved in the event, you may leave them blank.

Only numbers may be entered in these fields.

Hamilton
NRC
WRC

Technologies needed:

Select all that apply

Videoconferencing

Smart Board

Sites Participating in the Videoconference

PLEASE NOTE: You need to book at least 1 week (5 business days) in advance to ensure your VC will be processed. This will guarantee IT support staff can be scheduled for VC setup, otherwise support for the event cannot be guaranteed. No last minute requests can be arranged.

Select all that apply

Please select at least one answer

Hamilton

NRC Contact Info

A name and email of a participating student must be provided, or the room will not be booked. Answers of "TBA or TBD" will not be processed.

NRC Contact Name
NRC Contact Email

WRC Contact Info

A name and email of a participating student must be provided, or the room will not be booked. Answers of "TBA or TBD" will not be processed.

WRC Contact Name
WRC Contact Email

Comments

Is this a booking change?

Yes No

Booking Confirmation Number:

This is the number given to you when you first received confirmation of your booking.

Furniture Setup Required:

Yes No

Location/Room #:

Furniture Required:

Only numbers may be entered in these fields.

# of Tables:
# of Chairs:
# of Poster Boards:
# of Flip Charts:
# of Sign Stands:

Please specify a payment option:

Please note that for IG events held on weekends, housekeeping and room charges may apply and the student group will be responsible for payment through FHS room bookings

NOTE: Bookings and furniture set up cannot be directly charged to FHS research accounts. Requests submitted using a research account will not be processed. (ie: Accounts beginning with 8)

Choose one of the following answers

Account #
Cheque
Cash
No answer

Account #:

If furniture setup is required, an account # must be provided.