Reservation Request Form | School of Medicine IT

Primary Contact

Name: *

First Last

Phone: *

Email: *

Enter Email Confirm Email

Department Name:

Are you affiliated with the UNC School of Medicine *

Yes
No

Professor/Instructor(For courses/seminars)

Professor/Instructor Name:

Phone:

Event Information

Number of Rooms Requested:

Number of Participants per Room: *

Do you need a specific room/lab? If so, please list:

View a list of available rooms supported by SOM IT

This is a(n): *

Meeting
Course
Event

Event Name: *

Meeting, Course or Event Number

Date: *

Start Time *

: HH

MM

End Time: *

: HH

MM

Is this a recurring event? *

Yes
No

If So, Please List Additional Dates

List additional dates and times:

Setup/Cleanup Time

Approx. Set-Up Time (If Applicable):

: HH

MM

Approx. Clean-Up Time (If Applicable)

: HH

MM

Will there be food or drink served at your event? *

No
Yes

Equipment Information

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Equipment needs:

Computer
LCD Projector
Bringing Own Laptop
PowerPoint

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Operating System Information

I plan to use a Mac

By checking the above box, I acknowledge that it is my responsibility to contact SOM-IT at (919) 843-8884 to ensure the adaptability of the presenters' and event coordinators' materials to a Windows-based system.

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Other A/V Equipment needs:

Note: Please contact Facilities Services for tables, extra trash cans and recycle bins

Hidden

Will the event require A/V support?

Yes
No A/V support required

Hidden

I will need A/V support at these times:

At the specified setup time requested
At the meeting/course/event start time

At this time, requests for on-site event support are not being accepted. If your group will require a room orientation, you may enter a help request from our website or call our direct Classroom Support hotline at 919-843-9086.

You may also contact our hotline if you need A/V assistance while using our spaces or to report issues with the space's technology.

Vendor & Trade Show Information

I represent a vendor, potential vendor, or other entity doing business, or seeking to do business

Select this box if the business you represent manufactures or provides products and/or services used in patient care and/or research or if you are a vendor or a potential vendor of the UNC Health Care system

If so, you must contact vendorrelations@unch.unc.edu for approval before reserving this room

If your company organizes events for vendors, it is not prohibited from providing refreshments at the event, provided that the following guidelines are met:

It must be clear that your company, the event organizer, is offering and paying for the refreshments, as opposed to any of the vendors.
Your company is ultimately responsible for the vendors at the event, including providing each vendor with a copy of the Policy on Vendor Relationships Related to Biomedical Research or Patient Care. The vendors cannot give out food or other gifts of any nature or any value, even those trivial value.

Additional Information

Please note that room reservation does not include the surrounding areas such as lobby areas and Atrium. You must request such space when reserving a room if you are planning on utilizing these spaces
If serving food or beverages, be sure to clean and dispose of all trash following the event
All rooms must be left clean and furniture should be configured according to diagram provided in the room
Please note: The deadline for room reservation requests for Fall courses is July 1. The deadline for Spring requests is November 1
View our website for more details on reserving rooms: https://www.med.unc.edu/it/services/room-reservations/
For questions, please call the Scheduling Coordinator at (919) 843-8884

Please notify School of Medicine IT immediately of any changes or cancellations

Phone

This field is for validation purposes and should be left unchanged.