Name: Email:

Phone/Ext: Department:

Title of Event:

Type of Event: ---------- Conference/Workshop Education/Training Research Admistrative Number of Participants: ---------- 1-10 11-15 16-30 30+ (Auditorium)

Start Time (00:00 am or pm): End Time (00:00 am or pm):

Start Date (dd/mm/yyyy):

End Date (dd/mm/yyyy): ---------- Same as Start Date Recurring (list dates in box below)

List dates if this is a recurring event (maximum 2 years in advance):

Room Setup (see below for examples):
All Meeting Rooms are initially setup in Boardroom Style, unless otherwise requested.

A/V Requirements: ---------- Videoconference LCD Projector Teleconference Flip Chart

Catering Required: ---------- Yes. Contact: Lakeridge Health Retail Food Services 905.576.8711x4381 No

Additional Comments:
Please include Additional Comments or further explain your request HERE.

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