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Simulation Center New Event Request Form

First Name * Please enter your First Name

Last Name * Please enter your Last Name

E-mail * Please enter email address/username

Phone Please enter your phone

Event Name * Please enter your Event Name

Event Description * Please enter your Event Name

Event Date *

Start Time *

End Time *

Event Recurrence Rules

Recurrence

Recurrence Rules

Every days(s) *

Every Weekday

Recur Every week(s) on:

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Recur every month(s) on:

Day

The

Recur every years(s)

On

of

Recurrence dates:

End Event after occurrences.

OR

End After Date

Location *

Public?

Public Notes

Public Link

Category *

Class Title and Number if Applicable. (Enter NONE if Event is Other Than a Class) *

Please Check all Requested Equipment

SimMom

SimBaby

SimMan3G

Harvey

SimMan3G

SimMan3G

By checking this box and submitting this form you are agreeing to the Clinical Simulation Center policies and procedures. The Policy and Procedure Manual may be obtained by sending an email to the Simulation Center Coordinator, dkfarley@unr.edu *

Yes

Real Person Verification

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