Conference room reservation form for non-affiliated programs

1. Program/Department *

2. Meeting/Event name *

3. Contact person *

Person responsible for the use and maintenance of conference room

4. Contact phone *

5. Contact e-mail *

6. CHC Conference Room - UCSF Laurel Heights campus *

7. A/V required in room? *

No

Yes

8. Open to alternate conference room? *

No

Yes

9. Recurring Event? *

If yes, list additional dates in the notes section below (requests up to 6 months only)

No

Yes

10. Month *

Please choose month from drop list

11. Day of month *

Please select day of the month from drop list

12. Year *

Please select which year

2018

2019

13. Start time *

Please select start time from drop down

14. End time *

Please select end time from drop down

15. Conference room related notes

**Carefully review form before submitting**

The Center for Health and Community