Section 1: Contact Information
With area code. No dashes.
With area code. No dashes.
FDM Billing Information
Section 2: Activity Information
Section 3: Sponsor/Participants Information
Section 4: Activity Schedule
Activity 1
Activity 2
Activity 3
Activity 4
Activity 5
Section 5: Rooms Requested
Instructions: If this is an In Situ activity and a simulation room is not needed, complete the In Situ Request Form in addition to this form and skip remainder of this form.

Note: 
Rooms EL203H,E203F, EL203A, EL200G, EL 200F, EL203E, EL203B have an auxiliary control room that is included with the room requests.

Note: Every effort will be given to reserve the rooms requested; however, the MUSC Healthcare Simulation Center may substitute a comparable room if necessary due to scheduling conflicts.
Section 6: Scenarios



Section 7: Setup Requirements