Office of Student Affairs/Office of Medical Education

Room Reservation Request Form

Student Organization Name:
Student Contact:
Class: yyyy
MS
Phone Number: 412-XXX-XXXX
Pager: 412-XXX-XXXX
Email:
Date of Meeting mm/dd/yyyy
Start Time hh:mm
End Time: hh:mm
Projected number of people:
Topic of Meeting:
Type of room Requested
Will food be served?
If yes, from whom will the food be ordered?
Name of Student in charge of food
Do you need help from Donna with your food order
If yes, please contact Donna in the Office of Student Affairs for specifics.
Is AV equipment needed?
If yes, what type of equipment?
Do you need help with your AV Equipment order
If yes, please contact Andrew Labuda, asl11@pitt.edu or 648-8289 in the Office of Medical Education well in advance of your meeting date to discuss your exact AV needs (e.g., Will you require help with AV set up? using LCD projector; room computer or bringing own laptop? (if a Mac this requires special connections), need internet connection? Podium mic or wireless/lapel mics?) PLEASE, know your own and/or your speaker's exact AV needs to avoid problems and delays on your meeting day!

Special instructions/Remarks

Please contact Donna in Student Affairs if this meeting is cancelled for any reason.