Neuro Virtual Facilities Reservation Request Form

First name :  
Family name :  
Phone :  
Email :  
Name of key organizer :  

Meeting Information

Meeting Name :  
Meeting Date :  
Meeting Start Time :  
Meeting End Time :  
Virtual Room :  
Estimated # of attendees :  
Expected Audience :  

Technical Support

I require support :  

Event Management Requested

I require support with:  

If you require event management support, please complete the event proposal form here.

Additional information :  
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