Lab reservations

If you have any questions regarding reservations, you can email Sonia Lipp at slipp@mayfieldclinic.com or phone us at 513-569-5351

Lab requisition form:

Your name:

Email:

Telephone:

Sponsor:

Department:

Representative setting up lab:

Date Desired:

Start time:

Alternate Date:

Total # of Days:

Course Description:

May we use this course description on our MSIC website?

Yes

Number of stations:

Total number of Attendees:

Number of Surgeons:

Number of Reps:

Guest Speaker / Course Proctor:

Other (Please specify):

Tissue:

Is this a tissue lab?

Yes

Will you need help with cadaver/ specimen procurement:

Yes

If no, please describe pick up and drop off procedure:

Specific parameters for cadaver: (certain surgeries excluded, etc.)

Concierge:

Do you need marketing help?

Yes

Will food be provided?

Yes

Breakfast
Lunch
Dinner

Will you be making catering arrangements?

Yes

Would you like us to make these arrrangements?

Yes

If so, how many people?

Is there a monetary limit per person?

Do you need help arranging hotel accommodations?

Yes

If yes, do you have a hotel preference?

A/V

Do you have a didactic portion:

Yes

If yes, what is the timeframe for lecture?

Will you need a laptop/ PC?

Yes

If supplying own:

Mac

Equipment needs:

Does the lab require any of the following: Specialty Instruments (drills, basic tray, etc) C-Arm #, Microscope #, Suction, Cautery

Consumables

Any non-standard consumable needs?

Does Sponsor need:

PPE (Gown/Mask/Glove/Shoe cover/ Bonnet)

Lead Aprons/Thyroid Shields (check quantity)

Scrubs