education centre room booking form

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EDUCATION CENTRE ROOM BOOKING FORM
(External Users)
01) DATE(s) OF EVENT
02) ROOM REQUIRED (tick)
Training
Lecture Hall
Computer
Resuscitation Training
Clinical Skills
Practical Skills
Interview
03) ROOM LAYOUT (tick)
Theatre Style
Boardroom
Open Boardroom
Informal
Classroom
Cabaret
Interviews
Specialised Layout Required
04) CAPACITY (maximum numbers please)
05) TIME
 From
To
 Start time of event (if different)
06) IS THE EVENT? (tick)
Training/Educational
Committee/Management Meeting
Recreational
07) NAME OF EVENT ORGANISER
N.H.S.
Name
Non N.H.S
Address
Invoice Address (if different from above)
Purchase Order Number Required?
08) CONTACT DETAILS OF EVENT ORGANISER
(i.e.: name, email, telephone contact no :)
09) TOPIC/TITLE OF EVENT
10) NAME OF SPEAKER/TUTOR/CHAIRPERSON
11) WHO ARE YOUR TARGET LEARNERS?
12) IS THE AUDIENCE MULTIDISCIPLINARY? (tick)
Yes
No
12A) IF NOT, COULD IT BE? (tick & complete)
Yes
Under what circumstance? (e.g. larger venue)
No
Why? (e.g. specific teaching for a particular group)
13) ADDITIONAL EQUIPMENT / REQUIREMENTS
14) WILL REFRESHMENTS BE TAKEN IN THE ROOM? (tick)
Yes – Please read the guidelines on our confirmation letter.
No
15) ARE BREAKOUT ROOMS REQUIRED? (tick)
Yes
No
15A) IF YES

How many

Capacity

From (am)
To (am)

From (pm)
To (pm)
16) TODAY’S DATE
ROOM BOOKINGS MAY ONLY BE MADE USING THIS FORM.
PLEASE RETURN TO:
 [email protected]
The Education Centre
West Suffolk Hospital NHS Trust
Hardwick Lane, Bury St Edmunds
Suffolk
IP33 2QZ
IF YOU REQUIRE HELP TO COMPLETE THIS FORM, TELEPHONE 01284 713971
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