Scheduling Request Form
Please complete the information below in order to request a room to be scheduled through UAMS. The form should be used to request a room for academic distance education, continuing education, public education, administrative meetings and others to support the UAMS mission. Upon completion of the online request form an email confirmation will be sent to the requestor’s email address and the requestor may be contacted via phone to clarify details.
Please submit this request at least 2 business days prior to conference date/time to allow adequate processing time.  
I have read and agree to follow the Video Retention Policy
    Video Retention Policy  
Requestor Information
Requestor Name:
Last Name: *   First Name: *   Middle Inital:
   
Phone Number: *
  ext.:     Fax Number:  
E-Mail Address: *
Location/Department: *:
  Mail Slot Number:  
(COM/Neurosurgery, AHEC/Respiratory Theray, etc.)    
Conference Information
Presenter Name:
Last Name: *   First Name: *   Middle Inital:
   
Title of Conference: *
Date of Conference: *
Year:  Month:  Day:
   
Time of Conference: *
Hour:     Minute:      AM/PM:
  :      
Duration: * Hours   Minutes  
Number of Participants: *
*
*
If you select Yes for recorded, please click the appropriate link:  Internal Customer     External Customer
*
 

  If recurring, please enter recurrence details in the space provided or you can attach a document with occurence details.
    
Conference Location Information
  Room Resources:   Room Resources - Your Picks:
  Conference Location:   Conference Location - Your Picks:

Other Location:    


If yes, please enter the preferred room in the space provided.    

Additional Information:    
  If you have any questions, please click what the question is related to:      
I have read and agree to follow the UAMS Copyright Policy