MedEd Division of Medical Education
AudioVisual &
Room Scheduling

AudioVisual Request Form
If you need to schedule a room, please be sure to fill out the Room Request Form.
Please note that your AV order is not finalized until you receive written confirmation via email.
* Notes a Required Field
Step 1. Contact Info
* First Name:   * Last Name: 

* Phone:     () -

* Email:   Department:   Mail Code:  

 * Index Number:

 Step 2. Event Info
 * Event Title:

 * Location:   Including facility (SOM Campus, Hillcrest, or La Jolla) and room number

 * Start Date: (mm/dd/yyyy)   Calendar   * End Date: (mm/dd/yyyy)   Calendar

 * Actual Start Time: :   * End Time: :

 Recurring Event? Yes    No        If Yes, please indicate the repeat pattern (i.e. 1st Tuesdays, every Monday and/or specific dates)
 

 User's Name: (if different than contact name)
 Step 3. AV Equipment & Services
* I need the following equipment/services for this event:

Other AV equipment needs:

 Step 4. Additional Information




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