Heersink School of Medicine Event Request Form

HEERSINK SCHOOL OF MEDICINE EVENTS

EVENT REQUEST FORM

If you would like University Events to assist you in planning an event, please complete this form, and one of your team members will contact you shortly. This form is for UAB entities and subject to approval by management. All request must be submitted at least eight (8) weeks in advance for small-medium events (attendance 150 or less) and 4-6 months for larger events (expected attendance more than 150) for consideration.

The information in the first section is required. If you are not sure about one of the categories, such as date or budget, please provide an estimate.

Submission Date

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Submitter's Name;(*)

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Submitter Email:(*)

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Submitter Phone Number:(*)

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Contact Person Name (if different than the submitter)

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Contact Person Email

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Event Name: (*)

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UAB department/school hosting this event:(*)

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What type of event is this?(*)

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List the type of event(*)

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Expected attendance(*)

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Event Date(*)

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Event Time(*)

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Is there any flexibility with your date?

Yes

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Will you need an onsite coordinator the day of your event?

Yes

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Are you requesting University, HSOM, or Health System leadership to be in attendance?

Yes

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Name of leadership person in attendance

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Who will be the host of this event?

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Preference of digital or printed invitations?

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Attire for the event?

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Specific design elements (logos, a certain look in mind)

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Is signage/printed materials needed? Or a PowerPoint?(*)

Yes

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List your specific signage needs

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Are you requesting the Dean to speak?

Yes

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Will the Dean need talking points?

Yes

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What will the Dean be speaking about?

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Budget:(*)

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Billing Information(*)

Account Number

Educational Foundation Fund

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Account Number:

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If invitations or mailing:

Reminder: State funds may not be used to to purchase alcohol. Please provide details of the fund or method of payment intended.

If beer, wine, or spirits:

Cash bar

Open (hosted) bar

Combination of hosted drink tickets and cash bar, if approved

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If Other:

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Invitation list: The department requesting event assistance is responsible for providing an accurate and complete invitation list. A department employee will be responsible for creating an Excel list based on one of the templates below.

Electronic invitations: Excel spreadsheet with three columns for email, first name and last name.

Ex:

events example