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Skills Lab Reservation Form

Childbirth Simulator Reservation Form

 

Skills Lab Reservation Form
The Skills Lab will be scheduled on a first come, first served bases as reservation requests forms are received. A confirmation email will be sent to confirm the date and verify delivery. Please keep in mind that the skills lab is extremely expensive to mail. Please make arrangements to pick it up whenever possible.

The skills lab is on loan for one month at a time. It is due in our office one month from the date you pick it up or we mail it to you. Please respect the needs of other members and return the materials on time. It must be returned in good condition, clean and ready to go out again.


Reservation Form

First Name:
Last Name:
Title:
Facility:
Mailing Address:
Mailing Address2 :
City:
 State: Zip:
E-mail address:

Phone Number:
 ( ) -
Fax Number:
( ) -
 
Date Needed:
Will Return:
   
Alternate Date:
Will Return:
   
Materials Needed:

Posters Only
Skills Lab Only
All Materials
 
I will Pickup Materials
  On: (Date)
   
Please Mail Materials
  Mail On: (Date)

Comments:

 

 
 

email: jacobssa@slrmc.org • location: 103 W. State Street, Boise, Idaho 83702 • phone:(208) 381-4174