Name
*
Email
*
Phone Number
*
Format: (000)-000-0000.
Course Name
Company Name
Start Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Start Time
*
Hour Minutes
AM
PM
AM/PM Option
End Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
End Time
*
Hour Minutes
AM
PM
AM/PM Option
Large Conference Room
Standard Meeting ($175/hour)
Dental Subject ($125/hour)
Weekend and Evening w/ Dental Subject ($150/hr)
Weekend and Evening w/o Dental Subject ($200/hr)
Glass Conference Room
During the week ($45/hour)
Weekends ($125/hour)
Additional Facility Services
Non-Surgical Operatory ($60/hour)
Surgical Suite ($120/hour)
No. of hours the facility is needed
Please Select
1
2
3
4
5
6
7
8
9
10
Additional Request Notes
Acknowledgment
*
By submitting this request, I acknowledge that I am responsible for ensuring the conference room is returned to its original condition following use. This includes removing all personal items, disposing of trash, wiping down surfaces, returning furniture to its original arrangement, and reporting any damages or maintenance issues immediately. Failure to properly clean the facility may result in additional cleaning fees.
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