St. John's Hospital - Lebanon
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Tuesday, January 22, 2008

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Request for Materials from the SJHL Education Department

Please use the form below to request the use of rooms and equipment at St. John's Hospital - Lebanon.
Please complete all necessary blanks. If you have trouble with the form, please call Kelly Rhoades at 417-533-6338.

(If you would like to verify room availability before completing the form below, please e-mail Karen Coffman at St. John's Hospital - Lebanon and she will let you know what is available as soon as possible.)

Your Name:

Your E-mail Address:

Please Mark One:
New Event
Update to Event Already Scheduled

Please Mark One:
One Time Event
Ongoing Event

Event:

Date(s) Needed:
Please request actual dates, not just days of the week, to help prevent conflicts with holidays and other special events.

Specific Time or Length of Event:

Approximate number you are expecting to attend:

Will there be catering?:
No
Yes

Setup or Cleanup Time Needed? Any special notes or requests?:


Conference Room Requested:
None
Conference Rooms 1 - 2
Conference Rooms 3 - 4
Conference Rooms 1 - 4
Conference Room 5

(The Administrative Board Room is scheduled by Administration.)

Materials Requested:

Please be as specific as possible. Items may include:
  • TV/VCR/DVD Unit
  • LCD Projector
  • Portable Screen
  • Digital Camera
  • Video Camera and Tripod
  • Polaroid Camera
  • Laptop Computer
  • Laptop Remote for Presentations
  • Video Conferencing Equipment
  • Audio Conferencing Equipment
  • Overhead Projectors
  • Specific Audio/Video/DVD Titles
  • Flip Charts and Easels
  • CPR Equipment etc.

Date/Time You Will Pick Up from the Education Office (if applicable):

Date/Time You Will Return Materials to the Education Office (if applicable):

Any Other Important Information:


Page Information Updated: January 4, 2008.

All information © 2006, St. John's Hospital - Lebanon
100 Hospital Drive - Lebanon, MO 65536 - 417.533.6100
St. John's Hospital - Lebanon (formerly Breech Regional Medical Center) is a proud part of St. John's Health Systems and The Sisters of Mercy.
St. John's Hospital - Lebanon has earned the Joint Commission's Gold Seal of Approval. Safety or Quality Concerns?
St. John's Hospital - Lebanon is very concerned about your privacy. Please read our Patient Privacy Statement for more information.