*All Fields are Required*

Organization Name:

Contact Person:

Phone #:

E-mail:

Tentative Date:

Tentative Time (start-finish):

Tentative Location:

** DO NOT submit this form until you have personally contacted one of the following to reserve your room:                                                                                                                                               

Becky Vinson (All rooms in Grosvenor; Irvine rooms EXCEPT lecture halls or Bricks - 593-2544)

Mark Loudin (Irvine lecture halls and Bricks area - 593-2305)

See the instructions for details.**

Expected # of audience:

If food will be served at your event, you must comply with the Ohio University food policies.

Type of Event:

Please note:  You must request A/V equipment by contacting the Tech Shop at 593-2169 if your event will be held in Grosvenor or in any Irvine rooms other than 199 and 194.  Failure to do so will mean NO A/V available for your speaker.

Need Chairs?  Contact Dean Dupler (OUCOM Facilities, Grosvenor 009, 593-2118) to make arrangements.

Is your advisor aware of this event?   Yes No      If you select no, your request will not be processed.  You MUST inform your advisor! 

If an OU-COM alumnus is speaking at the event, e-mail Jill Harman, Director of Alumni Affairs, the date and time.  You can also contact Jill if you need to check and see if a speaker is a graduate.   

If the Dean's office should know about this event, contact Nancy Wilcox in (Grosvenor 204), and e-mail Anita Martin in Communications (Grosvenor 326). 

Will you be serving alcohol at this event?    Yes No    If yes, click here to review the OU-COM alcohol policy.

If this is a community service event, does it qualify for service learning?  (click here for the definition of service learning)    Yes No    If you need any educational material or visual aids for your event, contact the AHEC office (592-4051).  They have brochures, books, models, etc. pertaining to a multitude of health related topics that are available for students to borrow.

Will this event involve any clinical techniques or procedures (for example, taking blood pressures, diabetes finger sticks, etc.)     Yes No    If yes, a preceptor MUST be present, and you may need to attend a training session ahead of time.  Contact Sarah McGrew  (Grosvenor 311, 593-2518) to find out if training is required.