Please see the Guidelines for Events in the Medical Historical Library before submitting a request. Name of person responsible * Email of person responsible * Department * Phone # * Type of Event and Details Requested Date of Event * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202020212022202320242025 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? No 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. CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.