Conference Room Request Form

Conference Room Request Form

Friedman Brain Institute - Hess 9th and 10th Floors
- Reservations for individuals/groups not located on Hess 9th or 10th floors must be within normal business hours (9:00am-5:00pm, Monday through Friday).
- We do not allow recurring reservations for individuals/groups not located on Hess 9th or 10th floors.
- If the room is not in use within 15-minutes of reservation start time, reservation will be automatically cancelled
- All rooms have a PC, wall projector, a telephone and a white board with markers.
- Only HDMI connections can be used in these rooms (VGA is no longer supported). You must supply your own webcams and adaptors.
Please initial: I understand that the Neuroscience staff and staff of the Friedman Brain Institute (Hess 9th and 10th floors) have priority for use of our rooms and that, if needed, my reservation may have to be cancelled to accommodate them. I will receive 24 hour notification. *
Please initial
Please initial: I understand that no food is permitted in this conference room.*
Please initial
Please initial: I agree to make sure the projector is turned OFF after use.*
Please initial
Please initial: I agree to use the room for only the time allotted and to vacate when my reservation time ends.*
Please initial
Please initial: I understand that furniture cannot be moved in or out of the conference rooms. My department will be charged if anything is broken and requires replacement, or if cleaning, for which we would normally be charged, is required.*
Please initial
Provide Fund Number:*
XXXX-XXXX-XXXX
Room Request:

Hess 9-121 (Seats 18 ppl - 10 around table, 4 on each side of room)Hess 10-121 (Seats 16 ppl - 10 around table, 3 on each side of room)Hess 10-122 (Seats 18 ppl - 10 around table, 4 on each side of room)Hess 10-101 (seats 20 ppl - 10 around table, 5 on each side of room)
Date(s) Requested:*

MonthDayYear
Date
Start Time End Times*

:HourMinutesAM/PM Option
Until
until :HourMinutesAM/PM Option
Date(s) Requested:

MonthDayYear
Date
Start Time End Time

:HourMinutesAM/PM Option
Until
until :HourMinutesAM/PM Option
Brief Description of Event & list of recurring dates (if applicable)*

0/100
Number of People to be Accommodated*
Contact Name:*

First NameLast Name
Contact Phone Number*

Area CodePhone Number
Contact Email*

Confirmation Emailexample@mssm.edu or example@mountsinai.org
Contact Location
Hess 9th Floor, Room 000
Alternate Contact Name:

First NameLast Name
Alternate Contact Phone Number:

Area CodePhone Number
Alternate Contact Email:
example@example.com
Please initial: I understand that if I or the group for which I am reserving this room for don’t follow these guidelines, that we may be prohibited from making future reservations. *
Please initial
Please verify that you are human*
I understand that everyone will use hand sanitizer when entering the room. We will also clean the room with sanitizer wipes when we are done using the room.*
Please initial
NOTE: Chain of command for when Celisse is on PTO.

Hess conference rooms
• Celisse
• Nora
• Jubrainy
• Kayla
• Celine
• Vena
• Veronica
• Jenny
Should be Empty: