ERC Room Request

Which space would you like to request?*

Meeting Rooms
Simulation Lab

Name of Event*

Approximate Number of Attendees*

Who will be attending your event?*

Administrative Staff
Attending Physicians
Medical Students
Nurses
Outside Speaker/Guest
Resident/Fellow
Other (provide details in description box below)

(Please check all that apply)

What is your room preference?*

Room A (lecture setup, seats up to 126)
Room B (boardroom setup, seats up to 50)
Either Room A or Room B will work
Both Rooms A & B, as two separate spaces
Both Rooms A & B, combined into one large space

Please provide a brief description of your event.*

Will you be requesting an alteration to setup of the room?*

No
Yes

Please note, room reconfiguration may impact whether we can confirm your request depending on the other meetings scheduled in the space that day.

For a description of how our spaces are configured, visit: med.virginia.edu/erc-meeting-rooms/

Please provide a description of the reconfiguration alteration you are requesting:*

Contact Name*

First Last

Department*

Phone*

Email*

Is this a multi-day event?*

No
Yes

Will this be a recurring event?*

No
Yes

Will this be a recurring event in the Sim Lab?*

No
Yes

Frequency*

Weekly
Bi-weekly
Monthly
Quarterly

Week of the month*

Day*

Monday
Tuesday
Wednesday
Thursday
Friday

Start Date*

End Date*

End Date

Leave blank for perpetual booking requests.

Date*

What time do you want your RESERVATION to start?*

:

This is the time you'll have access to the room. Build in any setup time you need; most bookings require 15-30 minutes ahead of the event/meeting start time.

What time will your RESERVATION end?*

:

Please include time needed for clean-up, etc.

Will you need A/V tools or IT support?*

No
Yes

If you need access to any audio/video equipment, we will provide you with setup support and a brief training based on your event needs.

Will you need A/V tools or IT support?*

No
Yes

If you need access to any audio/video equipment, we will provide you with setup support and a brief training based on your event needs.

Please provide a description of the A/V support you need.*

Examples: PowerPoint presentation, microphones, etc.

Will you be having a virtual component with your event? (Zoom/Webex/Teams etc.),*

No
Yes

For all Virtual Meetings (Zoom/Webex/Teams etc.), a Host must be available to moderate a Meeting

If available, please list the contact name of your host.*

Will there be vendors, sales or service representatives participating in your event?*

No
Yes

Please confirm that you have read the UVA Health System Policy on vendors and will be in compliance with all procedures.*

I have read, understood and will comply with the policy

UVA Health System vendor policy: Policy 0013: Vendors, Sales and Service Representatives at the Medical Center

Will you have catering at this event?*

No
Yes

Will your event require parking?*

No
Yes

Contact Health System Parking Office*

I understand

The GME office does not have access to parking. Please contact the Health System Parking Office and complete an Event Parking Request Form and receive approval in advance.
» parking.virginia.edu/event-parking-request
» healthsystemparking@virginia.edu
» (434) 924-5147

Parking is very limited as parking resources are already committed to patients receiving their care here. There is no guarantee you will be approved for parking validations.

CAPTCHA

Room assistance is available for scheduled events between the hours of 7:00 am & 7:00 pm.

ERC Room Request Form