PITTMAN CENTER FOR ADVANCED MEDICAL STUDIES
Reservation Form

   

Rates:   Monday-Friday - $50     Weekends - $60

Scheduling: Jamye Hester        Telephone: 934-7442       Fax #: 934-3749        Email: jahester@uab.edu

 
 
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First Name
Middle Name
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Last Name
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Oracle Account String (*Grant accounts excluded)
*
Sponsoring Department
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Address1
Address2
*
City
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State
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Zip
Country
*
Email
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Phone
Alt Phone
Fax
   * Nature/Description of Event:
    
Type of Request NEW REQUEST       CHANGE      CANCELLATION
Event Date    Show Date Picker
Time Event Begins (include AM or PM) 
Time Event Ends (include AM or PM)    
Day of week that corresponds to date of event

ATTENDEES **If function will be attended by non-UAB audience, an Event Pre-Approval is required prior to reservation confirmation.
(fire code limits occupancy to 45 people maximum)
UAB Audience ONLY
**External Audience
 
Estimated Attendance 

Will this request be a continuous reservation?
YesNo

Checks from other entities (HSF, Eye Foundation), but not personal checks, are accepted for payment. Please check here if payment will be made this way and an invoice will be sent following the event.

A Journal Entry will be made for payment to this account following the event.
FOR BILLING QUESTIONS CALL 934-7466