MITIE Internal Event Request

Thank you for choosing MITIE to host your event!

Please complete this form with as much information as you can so we will better understand your needs and goals. Once MITIE receives this form, a project coordinator will be contacting you within two business days to discuss your request in more detail.

Event Details

Event Title * Event Requested By * Physician Fellow Resident Researcher Nurse Other Clinician (please specify) Other Staff (please specify) If other, please specify Department * Requester Name * Phone Number * Email Address * Requested Date [1st Choice] * Requested Time [1st Choice] * Requested Date [2nd Choice] Requested Time [2nd Choice] Lab Type * Dry Wet - Animate Wet - Cadaveric SIM 3G Manikin Explants Video (Broadcast, Livestream, and/or Recording) If wet lab requested list out; needs, quantity and procedures & specs If Animate Lab [Need PI Name] Space Requested * MRI Angio Suite CT OR Operating Room 1 Operating Room 2 Partial Task A Partial Task B Partial Task C Partial Task D PSL 6 PSL 9 SIM 1 SIM 2 Minor Room MPS Board Room Conference Room A Conference Room B Conference Room C Conference Room D Conference Room E Conference Room F Broadcast Studio A Broadcast Studio B Name of guest that will be attending or assisting with this request Name of non-Houston Methodist guest, if applicable Detailed Description *

Billing Information

Contact Name * Email Address * Department * Phone Number * VP responsible for approving internal transfer requests * Cost Center # for internal transfers * Fund # (if applicable) for transfers

Authentication *