Booking request form - Royal Marsden Hospital

Clinical Skills and Simulation Centre“Promoting excellence in heart, lung and cancer care”Booking Request FormPlease ensure that this form is completed fully - incomplete forms will not be processed. Room bookings willbe regularly monitored. This form should be emailed to: CSSC@rbht.nhs.uk1. Details of bookingSession title in fullSession dateStart andfinish timeSession organiser name,email address and telephonenumber/sTotal no. of participants forthis session includingtrainers/ speakersDetails: Please inform us ofthe purpose of session, whichdepartment or organisation isinvolved and the format, e.g.lecture, seminar, meeting2. Preferred RoomsYour room preferences will be taken into account, but cannot be guaranteed. If your booking isaccepted, the rooms you have been allocated will be confirmed to you on receipt of your booking.Seminar 1 & 2 can be linked, as can Seminar 3 & 4 and the Skills and Simulation Lab.RoomsSeminar Room OneSeminar Room TwoSeminar Room ThreeSeminar Room FourSimulation Laboratory ( please state if you need 3G Sim Man )Skills LaboratoryControl RoomUse of the whole centrePlease tick(multiple if required)3. FinanceWill you receive payment from candidates?(please tick)Will you receive funding for your event?(please tick)YesYesNoNoPage 1 of 2

4. Equipment requested (please see our list)a. Audio Visual and otherequipment.b. 3G Sim ManPlease note that there is a separate booking form for 3G SimMan if youneed remove him from the skills centre (see website for details orcall/email the centre to check availability).Please note that non-profit bookings will need to loan/ purchase their own equipment from theCSSC or other sources. Equipment can be provided for profit making courses at an extra cost.5. Use of animal productsWill animal products be used during your session/s?(please tick)YesNoIf yes, please provide details of the delivery of animal products and session start/ completiontimes. You will also need to read and agree to the rules in the Hazardous Waste Policy which willbe emailed to you on receipt of this form.6. CateringAre you ordering catering for this session?(please tick)YesNoFor catering orders contact James Varghese on: j.varghese@rbht.nhs.uk Please note that it is yourresponsibility to ensure that the facilities you use are used appropriately. If the room is left in a mess,then the CSSC reserves the right to recharge you for any additional cleaning.7. SignatureBy signing this document you are indicating that the content of this form is true and accurate, andthat you agree to the terms of the booking (if accepted) including our policies. Forms can be emailedfrom a Royal Brompton or Royal Marsden email address – with the session organiser acceptingaccountability on the same basis as a written signature.Signature of sessionorganiserDatePage 2 of 2