Heersink School of Medicine Event Request Form - Advancement

HEERSINK SCHOOL OF MEDICINE EVENTS

EVENT REQUEST FORM

If you would like University Events to assist you in planning an event, please complete this form, and one of your team members will contact you shortly. This form is for UAB entities and subject to approval by management. All request must be submitted at least eight (8) weeks in advance for small-medium events (attendance 150 or less) and 4-6 months for larger events (expected attendance more than 150) for consideration.

The information in the first section is required. If you are not sure about one of the categories, such as date or budget, please provide an estimate.

Submission Date

Invalid Input

Submitter's Name;(*)

Invalid Input

Submitter Email:(*)

Invalid Input

Submitter Phone Number:(*)

Invalid Input

Contact Person Name (if different than the submitter)

Invalid Input

Contact Person Email

Invalid Input

Event Name: (*)

Invalid Input

UAB department/school hosting this event:(*)

Invalid Input

What type of event is this?(*)

Invalid Input

List the type of event(*)

Invalid Input

Expected attendance(*)

Invalid Input

Event Date(*)

Invalid Input

Event Time(*)

Invalid Input

Is there any flexibility with your date?

YesNo Invalid Input

Will you need an onsite coordinator the day of your event?

YesNo Invalid Input

Are you requesting University, HSOM, or Health System leadership to be in attendance?

YesNo Invalid Input

Name of leadership person in attendance

Invalid Input

Who will be the host of this event?

Invalid Input

Preference of digital or printed invitations?

Invalid Input

Attire for the event?

Invalid Input

Specific design elements (logos, a certain look in mind)

Invalid Input

Is signage/printed materials needed? Or a PowerPoint?(*)

YesNo Invalid Input

List your specific signage needs

Invalid Input

Are you requesting the Dean to speak?

Yes No Invalid Input

Will the Dean need talking points?

YesNo Invalid Input

What will the Dean be speaking about?

Invalid Input

Budget:(*)

Invalid Input

Billing Information(*)

Account NumberEducational Foundation Fund Invalid Input

Account Number:

Invalid Input

Please select the event tasks with which you want assistance:

If invitations or mailing:

If venue:

If parking:

If Menu:

If Beverages:

Reminder: State funds may not be used to to purchase alcohol. Please provide details of the fund or method of payment intended.

If beer, wine, or spirits:

Cash bar

Open (hosted) bar

Combination of hosted drink tickets and cash bar, if approved

Invalid Input

If Other:

Invalid Input

Invitation list: The department requesting event assistance is responsible for providing an accurate and complete invitation list. A department employee will be responsible for creating an Excel list based on one of the templates below.

Electronic invitations: Excel spreadsheet with three columns for email, first name and last name.

Ex:

events example

Print invitations: Email Freddie Mullins at freddiem@uab.edu to request templates.

Upload invitation list:

Invalid Input

Verify Captcha(*)

Invalid Input

EVENT REQUEST FORM

Give Online

Give By Phone

Give By Mail