E-mail Address:
*
Requesting Person:
*
SHHEC Department or Requesting Organization:
*
Phone Number:
*
Todays Date
*
Please Check Tyel of Event: (Internal = SHHEC Associates, External = Community)
*
Internal ONLY
External ONLY
BOTH Internal and External
Physician ONLY
Title of Event:
*
Date of Event:
*
Alternate Event Dates:
Time of Event (i.e. 6:00 am - 4:00 pm):
*
Set-up Time Required (i.e. 30”):
*
Number of People Expected:
*
Specific Room Requested:
*
None - I am requesting ANY available room
Administration Boardroom
Family Birth Place Education Room
Suite One Education Room
Suite Three Conference Room
Room Setup Requested:
*
To be determined
No Set-Up Required
Admin Boardroom: No set-up required (Max Capacity: 16)
Family Birth Place: U Style (Max Capacity: 12)
Suite One: Classroom Style (Max Capacity: 16)
Suite Three: Classroom Style
Suite Three: E Shape
Suite Three: Group Discussion
Suite Three: Theater Style
Suite Three: U Style
Attach Your Specific Setup Room Diagram (this may be in the form of a Word Document, Adobe Document, etc.):
Audio/Visual Needs:
*
None
Laptop Computer
Computer Projector
Slide Projector (MUST provide own carousel)
TV/DVD/VCR
Microphone
OTHER
Audio/Visual Needs - Other (Please identify what other audio/visual needs you have that were not indicated above).
*
Required