Mass General Hospital - Department of Radiology - REMS - Audio Visual Equipment Reservation Form

Radiology Educational Media Services (REMS) (View Map) 2 Emerson Place (basement) Boston, MA 02114	Phone: 617-726-8335
	Fax: 617-726-7508
	Email: REMS@partners.org

If your request is urgent or you require assistance with this form, please call 617-726-8335

GENERAL INFORMATION - ALL FIELDS ARE REQUIRED

First Name:

Last Name:

Phone #

Email Address:

Presentation Requirements:

LCD Projector (includes laser pointer and extension cord)

Laptop (inlcudes mouse, laser pointer, and wireless PPT remote)

Internet / Intranet Access

35mm Slide Projector

Screen ($100/day surcharge, min. 3 days advance notice)

Portable Audio Speaker

Other

PLEASE COMPLETE SECTION A OR SECTION B

SECTION A - FOR EQUIPMENT LOAN ONLY

SECTION B - FOR EQUIPMENT SET-UP BY REMS

Pick-up Date: Limited to weekdays only
[ View Calendar ]

Meeting Date: Limited to weekdays only
[ View Calendar ]

Pick-up Time:

Meeting Start Time:

Drop-off Date: Limited to weekdays only
[ View Calendar ]

Is your meeting place reserved 30 minutes prior to the start of your meeting for set-up?

YES *Preferred by REMS staff

NO *This might delay the start of your meeting

Drop-off Time:

Meeting / Event Location:

Meeting End Time:

Meeting Location:
(include specific floor and room number)

Please make sure you have completed all fields in section A or B before submitting this form.