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The University of British Columbia

Faculty of MedicineDepartment of Physical Therapy

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Room Booking Request Form

Booking Contact Details
Name*
First Last
UBC Faculty and Department Affiliation (or Name of Organization)*
Phone*
Email*
Booking Request
Event Title*
Date request for room booking*
If you are requesting bookings that cover more than one day, please write your requests below in the Additional Notes or Requests field at the end of this form.
Please include ALL dates (do not choose a date here) and indicate room/s, date/s and timeframe/s requested.
DD slash MM slash YYYY
Start time

: Hours

Minutes

AM/PM
End time

: Hours

Minutes

AM/PM
Room(s) requested
- Boardroom* (#237)
- Breakout Room** (#141)
- Breakout Room** (#142)
- Other
*Located in the Department Administration Suite, 2nd floor, Freidman Bldg. (2177 Wesbrook Mall)
**Breakout Rooms are located on the 1st floor, Freidman Bldg.
Other Room Location(s)
Do you require a video conference connection?*
- Yes
- No
Do you require a teleconference connection?*
- Yes
- No
Do you require technical support?*
- Yes
- No
Technical Notes and Requests*
Additional Notes or Requests
Please include any additional information, requests or questions here.
Please include any additional information, requests or questions here.

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Department of Physical Therapy

Faculty of Medicine

212 Friedman Building

2177 Wesbrook Mall,

Vancouver, BC Canada V6T 1Z3

Tel 604 822 8225

Website physicaltherapy.med.ubc.ca

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