-VANDERBILT SCHOOL OF MEDICINE ELECTRONIC ROOM REQUEST FORM-

(Now accepting reservations through July 31, 2008)

Department Address Building +4 Zip Contact Name Contact Phone Person in Charge of Event  (If other than Contact Name) Contact Email Address Type of Event (Description or event name that will appear on daily schedule) Medical School/IGP Course Name Med/IGP Course # Type of Attendees - Check all that apply Medical/IGP Students Faculty Staff Residents Other (Please List if "Other")   Yes No Will refreshments be served? (Choose "Yes" or "No") If so, what type? (Prior Approval Required) Security Contact (Provide ONLY for events scheduled prior to 6:00am or after 6:00am Monday through Friday or weekends) S M T W T F S Start Date End Date Start Time End Time # of Attendees/Room # of Rooms Room Requested Room 202 RLH Room 208 RLH Room 213 RLH Room 214 RLH Room 306A RLH Room 306B RLH Room 306K RLH Room 350 RLH Room 407A RLH Room 407B RLH Room 407C RLH Room 407D RLH Room 411A RLH Room 411B RLH Room 411C RLH Room 411D RLH Room 412 RLH Room 415A RLH Room 415B RLH Room 415C RLH Room 415D RLH Room 419A RLH Room 419B RLH Room 419C RLH Room 419D RLH Lab 410 RLH Lab 425 RLH Room 431 RLH Room 433 RLH Room 437 RLH Room 439 RLH Room 504 RLH Room 512 RLH Room 206 PRB Room C2209 MCN Room 1220 MRB-III Room 1230 MRB-IV Room 8323 MCE Room 8337 MCE Room 8349 MCE Room 8380A MCE Room 8380B MCE Room 202 RLH Room 208 RLH Room 213 RLH Room 214 RLH Room 306A RLH Room 306B RLH Room 306K RLH Room 350 RLH Room 407A RLH Room 407B RLH Room 407C RLH Room 407D RLH Room 411A RLH Room 411B RLH Room 411C RLH Room 411D RLH Room 412 RLH Room 415A RLH Room 415B RLH Room 415C RLH Room 415D RLH Room 419A RLH Room 419B RLH Room 419C RLH Room 419D RLH Lab 410 RLH Lab 425 RLH Room 431 RLH Room 433 RLH Room 437 RLH Room 439 RLH Room 504 RLH Room 512 RLH Room 206 PRB Room C2209 MCN Room 1220 MRB-III Room 1230 MRB-IV Room 8323 MCE Room 8337 MCE Room 8349 MCE Room 8380A MCE Room 8380B MCE Room 202 RLH Room 208 RLH Room 213 RLH Room 214 RLH Room 306A RLH Room 306B RLH Room 306K RLH Room 350 RLH Room 407A RLH Room 407B RLH Room 407C RLH Room 407D RLH Room 411A RLH Room 411B RLH Room 411C RLH Room 411D RLH Room 412 RLH Room 415A RLH Room 415B RLH Room 415C RLH Room 415D RLH Room 419A RLH Room 419B RLH Room 419C RLH Room 419D RLH Lab 410 RLH Lab 425 RLH Room 431 RLH Room 433 RLH Room 437 RLH Room 439 RLH Room 504 RLH Room 512 RLH Room 206 PRB Room C2209 MCN Room 1220 MRB-III Room 1230 MRB-IV Room 8323 MCE Room 8337 MCE Room 8349 MCE Room 8380A MCE Room 8380B MCE Room 202 RLH Room 208 RLH Room 213 RLH Room 214 RLH Room 306A RLH Room 306B RLH Room 306K RLH Room 350 RLH Room 407A RLH Room 407B RLH Room 407C RLH Room 407D RLH Room 411A RLH Room 411B RLH Room 411C RLH Room 411D RLH Room 412 RLH Room 415A RLH Room 415B RLH Room 415C RLH Room 415D RLH Room 419A RLH Room 419B RLH Room 419C RLH Room 419D RLH Lab 410 RLH Lab 425 RLH Room 431 RLH Room 433 RLH Room 437 RLH Room 439 RLH Room 504 RLH Room 512 RLH Room 206 PRB Room C2209 MCN Room 1220 MRB-III Room 1230 MRB-IV Room 8323 MCE Room 8337 MCE Room 8349 MCE Room 8380A MCE Room 8380B MCE Room 202 RLH Room 208 RLH Room 213 RLH Room 214 RLH Room 306A RLH Room 306B RLH Room 306K RLH Room 350 RLH Room 407A RLH Room 407B RLH Room 407C RLH Room 407D RLH Room 411A RLH Room 411B RLH Room 411C RLH Room 411D RLH Room 412 RLH Room 415A RLH Room 415B RLH Room 415C RLH Room 415D RLH Room 419A RLH Room 419B RLH Room 419C RLH Room 419D RLH Lab 410 RLH Lab 425 RLH Room 431 RLH Room 433 RLH Room 437 RLH Room 439 RLH Room 504 RLH Room 512 RLH Room 206 PRB Room C2209 MCN Room 1220 MRB-III Room 1230 MRB-IV Room 8323 MCE Room 8337 MCE Room 8349 MCE Room 8380A MCE Room 8380B MCE Remarks