The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit North American phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

2EvSZHKsWP3KbzSXWsSpRzh7DeuxesVtqp5ZBLxu3VM9

Scheduling IPSC Events

Every attempt will be made to accommodate the requested schedules. We will review event requests after the early scheduling deadline and construct the schedule within 15 days. Our policy is first come, first serve. Conflict resolution meetings will be scheduled within 1-2 weeks.

DEADLINES for Early Scheduling:

For SPRING/SUMMER: January 1 - June 30

Event Request Form by September 15 or earlier.
Final confirmation of early requests will be sent out on or before October 15th.

For FALL: July 1 - December 31

Event Request form by March 15 or earlier.
Final confirmation of early requests will be sent out on or before April 15th.

Today's Date:

* must provide value

Event Type:

* must provide value

Event Name and Course Number:

* must provide value

Contact Name:

* must provide value

Department:

* must provide value

Email:

* must provide value

Phone Number:

* must provide value

Account Number for IDT for SP Expenses

Please list up to six (6) preferred dates, along with the time and type of event.

* must provide value

Expand

Please list up to three (3) alternate dates, along with the time and type of event.

* must provide value

Expand

Please include a brief description of your event.

* must provide value

Expand

Upload a Word document or PDF of the services you're requesting.

Upload file

Will you need your event recorded?

* must provide value

Yes

reset

Please list the equipment needed for this event (i.e. task trainers):

* must provide value

Expand

Please list the consumables required for this event (skills kits, PIVs, etc.):

* must provide value

Expand

Purpose of event (check all that apply):

* must provide value

Testing

Teaching

Tour

Task Training

Manikins

Recording

Research

Other

What space/room(s) are needed for your event? Check all that apply.

* must provide value

IPSC Classroom

IPSC Front Lab

IPSC Back Lab

IPSC Flex Lab

IPSC Birthing Suite

IPSC Operating Room

Telehealth Room 1 (ED II 5/138D)

Telehealth Room 2 (ED II 5/102)

NAP (Nurse Anesthesia Prgm.) Lab (ED II 5/102C)

Shorey Conference Room

Shorey Lab

Med Room

Please provide the total number of learners and their level.

* must provide value

Please provide the total number of faculty that will be associated with the event.

* must provide value

Please provide your signature:

* must provide value

Add signature

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