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In order to enhance  the learning experience of the UofM students  an Event  Coordinator  from the  department is normally  required to facilitate   student/preceptor room placement/set up  at the beginning of each session. The event coordinator  can  leave the facility after the students/preceptors are settled in their rooms.

Event Coordinator Name
Booking/ Tour  requested by:  
Note: A copy of this form will be emailed to this address upon completion.
Send me this email as HTML instead of plain text.
Phone Number 

Name of instructor(s)/Tour Lead

Title/Name of Session
Type of Program
Session/Department Coordinator
Type of session

Date of  Event

Setup Time Startmm/dd/yyyy
Session Start Timemm/dd/yyyy
Teardown Start timemm/dd/yyyy
Alternate Date and Time
Comments/ Additional Booking Information

(you may add the  date and time of  the recurring sessions of the same type)

 Submit as HTML
Duration of the booking

Number of rooms required 

 For Tour bookings please indicate the number 0
If the intended use will impact adjacent rooms due to noise or other disruptions, the booking must include ALL rooms.Would you like to book all rooms ?
Type of Room (Press CTRL to select multiple rooms)

Other Services   (click "None"  for a tour)


Goals and objectives of the session

 Submit as HTML

Number of participants

Type of Equipment (Press CTRL to select multiple equipments)

Support needs for (Press CTRL to select multiple choices)

Supplies (Press CTRL to select multiple supplies)
Would you like to use the Online exam system ?
Internet access is ONLY available upon request, do you need access to the internet?

Please specify how many internet computers you require for this session.