Room Bookings Please submit this form so the department can make a decision re use of rooms. Your Name:* First Last Your Email:* Your Role* Student Coordinator Core Faculty Status-Only Faculty / Alumni Staff Department*OS&OTPTSLPRSIOtherTitle of event:*Brief description (1-2 SENTENCES):*Is this a ...?* Course Meeting Date(s) of event* Time Frame (ex 1 pm - 2 pm) for each date* Name of Instructor or speakers(s), their title and affiliation(s)* Is this event sponsored?*NNoIf yes please address U of T Faculty of Medicine’s Sponsorship Policy guiding principles and issues concerning transparency, biases, marketing, gifts, etc. https://www.cpd.utoronto.ca/reports/CPD-Commercial-Sponsorship-Policy-2018.pdf Are there potential conflicts of interest?*YesNoIf yes, please submit a completed and signed disclosure declaration formMax. file size: 64 MB.Download: Disclosure Declaration FormMaximum Enrollment:*Intended Audiences (check all applicable)* UofT Students Status-Only Faculty Clinicians and Partners Alumni Public Does the instructor have insurance?* Yes No Is there a fee for students?* Yes No If yes, amount per student in CAD: If yes, is the fee for students discounted?* Yes No Is the session/course for profit or based on cost recovery only?* Profit Cost Recovery No Cost What rooms are requested?* Have you ever booked a room at 500 University before?* Yes No Is A/V equipment required for this event?* Yes No Note: extra costs may be chargedIf yes, please describe: Are technician services required?* Yes No Note: extra costs may be chargedIs security required (weekends; weekdays after 5 pm)?* Yes No Note: extra costs may be charged