FSM Room Reservation Request Form

If you do not have access to the VEMS site please fill out this form to request space in the Robert H. Lurie Medical Research Center, the McGaw Pavilion and the Simpson Querrey Biomedical Research Center. Before completing, please view availability of space at https://fsmfacility.northwestern.edu/virtualems/BrowseForSpace.aspx

Department
1st Contact Name
1st Contact Phone Number 1st Contact Phone Number - ### - ### ####
1st Contact Email
2nd Contact Name
2nd Contact Phone Number 2nd Contact Phone Number - ### - ### ####
2nd Contact Email
NU Chart String Number - This must now include a five digit account code. If catering is processed for this reservation, this is the chartstring that will be charged.

Please Note: Only uses numbers, no dashes. You must add your Chartstring Fund, Department and Account Code in order for your request to be processed. FSM does not charge room rental fees. Chart Strings are required in case of no shows, late cancellations or damages.
Date Date / MM / DD YYYY
Do you have additional or alternate dates?

Do you have additional or alternate dates? Yes - Additional Yes - Alternate Over Night Set-Up/Break-Down
Type Additional Dates here
Type Alternate Dates here
Overnight Set-Up/Break-down dates
Event Start Time
Please consider any set-up that may be required when requesting a start time below. This is the event start time. Event Start Time
Please consider any set-up that may be required when requesting a start time below. This is the event start time. : HH MM AM/PM
Event End Time
Please consider any break-down that may be required when requesting a end time below. This is the event end time Event End Time
Please consider any break-down that may be required when requesting a end time below. This is the event end time : HH MM AM/PM
Set-Up Time
List the set-up time needed for this event. If it is an overnight set up, please indicate in additional dates above. If there is no set-up/breakdown needed, please list same times as the event. Set-Up Time
List the set-up time needed for this event. If it is an overnight set up, please indicate in additional dates above. If there is no set-up/breakdown needed, please list same times as the event. : HH MM AM/PM
Break-down Time
List the break-down time needed for this event. If it is an overnight break-down, please indicate in additional dates above. If there is no set-up/breakdown needed, please list same times as the event. Break-down Time
List the break-down time needed for this event. If it is an overnight break-down, please indicate in additional dates above. If there is no set-up/breakdown needed, please list same times as the event. : HH MM AM/PM
Event Title
Event Types

Please familiarize yourself with the event types before choosing the most appropriate one for your event (a brief description of each is listed below):

Department Research: Experiments and exploration of ideas that are not externally funded; nor are they discrete projects separately budgeted and accounted for.

Industry Clinical Trial: Clinical trials funded by industry, typically pharmaceutical companies; participation of human subjects.

Instruction: Teaching activities, training activities supported by institutional funds.

Non-University Activity: Space used by a non-NU entity.

Other Institutional Activity: NU public service, unallowable activities, student activities, auxiliary enterprises, and agency activity.

Other Sponsored Activity: Sponsored public service, contract for service activities, seminar and conferences.

School/Department Administration: Administrative space in academic units.

Sponsored Research: Space for externally funded research and development, university research, and cost sharing benefiting this research; this research is separately budgeted and accounted for.

Sponsored Training: Training activities funded by outside agencies and organizations.

Student Services Administration: Administration of student affairs and for services to students.

Industry Clinical Trial: Clinical trials funded by industry, typically pharmaceutical companies; participation of human subjects.

Instruction: Teaching activities, training activities supported by institutional funds.

Non-University Activity: Space used by a non-NU entity.

Other Institutional Activity: NU public service, unallowable activities, student activities, auxiliary enterprises, and agency activity.

Other Sponsored Activity: Sponsored public service, contract for service activities, seminar and conferences.

School/Department Administration: Administrative space in academic units.

Sponsored Research: Space for externally funded research and development, university research, and cost sharing benefiting this research; this research is separately budgeted and accounted for.

Sponsored Training: Training activities funded by outside agencies and organizations.

Student Services Administration: Administration of student affairs and for services to students.
Industry Clinical Trial: Clinical trials funded by industry, typically pharmaceutical companies; participation of human subjects.

Instruction: Teaching activities, training activities supported by institutional funds.

Non-University Activity: Space used by a non-NU entity.

Other Institutional Activity: NU public service, unallowable activities, student activities, auxiliary enterprises, and agency activity.

Other Sponsored Activity: Sponsored public service, contract for service activities, seminar and conferences.

School/Department Administration: Administrative space in academic units.

Sponsored Research: Space for externally funded research and development, university research, and cost sharing benefiting this research; this research is separately budgeted and accounted for.

Sponsored Training: Training activities funded by outside agencies and organizations.

Student Services Administration: Administration of student affairs and for services to students.
Event Type
Number of participants
Audio Visual: Please indicated if you plan to use AV for this event. (Please Note: AV equipment may not be available in each room)

Audio Visual: Please indicated if you plan to use AV for this event. (Please Note: AV equipment may not be available in each room) Yes No
Catering: Please indicate if you plan to provide refreshments at this event.

Catering: Please indicate if you plan to provide refreshments at this event. Yes No
Alcohol: Please indicate if you plan to serve alcohol at this event.

Alcohol: Please indicate if you plan to serve alcohol at this event. Yes No
Robert H. Lurie Building - Event Information

This document will help with all aspects of planning your event with catering and furniture moves in the Ryan Family Atrium.

https://fsmfacility.northwestern.edu/vEMSDocs/LurieBuilding.pdf
Robert H. Lurie Medical Research Center Rooms (capacity).
Please check all requested rooms.

Robert H. Lurie Medical Research Center Rooms (capacity).
Please check all requested rooms. WEST SIDE - Ryan Family Atrium Hughes Auditorium (250) Baldwin Auditorium (100) Searle Seminar Room (40) Gray Seminar Room (40)
Simpson Querrey Biomedical Research Center Rooms (capacity)
Please check all requested rooms.
(Please note: SQBRC spaces cannot be reserved more than 6 months in advance.)

Simpson Querrey Biomedical Research Center Rooms (capacity)
Please check all requested rooms.
(Please note: SQBRC spaces cannot be reserved more than 6 months in advance.) Simpson-Querrey Auditorium 1-230 (165) Krantz Conference Room 1M-200 (16) Treinens Conference Room 1M-209 (30) 2-200 (20) 1M-205 (6) 1M-206 (6) 1M-210 (10) 2-220 (16) Potocsnak Family Atrium (200)

These spaces will not be available for reservations until after July 1, 2019.
McGaw Pavilion Rooms (capacity).
Please check all requested rooms.

McGaw Pavilion Rooms (capacity).
Please check all requested rooms. Daniel Hale Williams Auditorium (170) Kellerman Classroom (45) 1-401 (50) 2-319 (12)* 2-321 (12)* 2-402 (16)* 2-403 (16)**

* These rooms only have projection screens - all other audio visual equipment must be provided by the user (including: computers, projectors, connection cords, etc.)

** This room has a plasma screen and connections cords - all other audio visual equipment must be provided by the user (such as a laptop)
Rubloff 6 Small Conference Rooms (capacity).
Please check all requested rooms.

Rubloff 6 Small Conference Rooms (capacity).
Please check all requested rooms. Rubloff 6-637 SCRDG Conference Room (10)

Rubloff 6-637 only has a whiteboard. All AV must be provided by the user. There is a phone in this space.
Notes
Please provide any additional information about your event.
FSM Confirmation Conditions

Please follow the below link to review the FSM Confirmation Conditions for the use of FSM public space.

https://fsmfacility.northwestern.edu/vEMSDocs/ConfirmationConditions.pdf
Confirmation Conditions

Confirmation Conditions I understand and agree to the policies as listed above. By clicking this box, I agree to follow the policies outlined above.

FSM Room Reservation Request Form

FSM Room Reservation Request Form

Event Types Please familiarize yourself with the event types before choosing the most appropriate one for your event (a brief description of each is listed below):

Robert H. Lurie Building - Event Information

FSM Confirmation Conditions

Event Types

Please familiarize yourself with the event types before choosing the most appropriate one for your event (a brief description of each is listed below):