Request to Book the Medical Historical Library

Name of person responsible *

Email of person responsible *

Department *

Phone # *

Type of Event and Details

Requested Date of Event *

Month

Day

Year

Start and End Times of Reservation

Please remember to include setup/cleanup time in your reservation. Also, please include anticipated start and end times for your event.

Catering Staging Area Needed?

Yes

Check this box if your caterer will need the Simbonis Conference room as a staging area for your event.

Charging Instructions COA: *

Digital Signature *

I have read the Guidelines and Procedures for the use of the Medical Historical Library and will adhere to them.

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.