UMKC  SCHOOL  OF  DENTISTRY
ROOM  SET-UP  FORM

UMKC SOD Funded/Sponsored Meeting/Event
Today's Date:
Date of Event:
If your event is scheduled less than one week from the form submission date, send an email to umkcdentalmaintenance@umkc.edu detailing your request
Name of Event:
Room(s) Used (select all rooms that are needed):

4th Floor Foyer
Canteen
Room 202
Room 209
Room 217A
Room 217B
Room 217C
Room 217D
Room 250
Room 365
Room 403 (Northwest Conf Rm)
Room 440 (Lrg Conf Rm)
Faculty Lounge
Other
Contact Information
Contact Organization/Department:
Contact First Name:
Contact Last Name:
Contact E-mail:
Contact Phone:
Begin Time: AM PM
End Time: AM PM
Number of attendance:
Entrances Used:
Biomedical Communications
(please check what is needed)
Audio Visual: Yes No s

Building/Room Access
(please check what is needed)

Require NORTH door card-access to be unlocked:

 Yes No
Time door to be unlocked: AM PM
Time door to be locked: AM PM
Set Up/Tear Down
Set-up time: AM PM
Date:
Tear-down time: AM PM
Date:

Assist in cleaning:
*Meeting organizer is responsible to leave room as it was found

If you answered Yes, select options:

Yes No


Trash pickup
Wipe Down Tables
Vacuum
MoCode for Custodial Service Charge

Weekday events after 4:30pm that will have more than 50 people involved will be charged a 4-hour minimum custodial service charge, and the event organizer must provide a MoCode to charge for the custodial service charge for the event.
Weekend events that involve food, regardless of the number of attendees, will be charged a 4-hour minimum custodial service charge, and the event organizer must provide a MoCode to charge for the custodial service charge for the event.
Cleaning service will include trach removal, wiping down tables/benches, and vacuuming. Contact Valorie Moore-Porter at mooreporterv@umkc.edu with questions.
Required to work overtime: Yes No

Number of grey 6-foot tables:
*Limit of 15 tables

Please describe table setup. Send diagram to kippera@umkc.edu if needed.

Recycle Bin: Yes No
Trash Bin:: Yes No
Items in the section below are available for meetings and events that are funded by the School of Dentistry.
Please contact Vicki Van Noy or Anne Kipper with questions.
Number of paper table covers:
Paper products:

Plates
Napkins
Forks
Spoons
Knives
Type of outside food ordered:

Types of Drinks Requested::

MUST BE REQUESTED 2 WEEKS PRIOR TO THE EVENT

SOD does not provide ice for events

 Coffee Supplies for coffee are provided. Event requestor responsible for making the coffee
Water
Soda
Container for drinks
Size of container requested::