Garfield Center Activity Request

Please submit answers to these questions. You will be confirmed via email and provided with additional logistics information.

Requesting Person's Name:
Phone Number:	(i.e., 925.555.4481)
Email Address:	(i.e., john.doe@kp.org)
Sponsoring Person's Name:
Sponsoring Person's Department (no acronyms):
Sponsoring Person's Region:
Date and Time of Proposed Activity (including setup time):	(Open Mon. to Thurs. 8am-5pm only)
How many people be involved:
Which region(s) will be involved:
Does your group contain any non-KP employees (consultants, vendors or contractors)? If so, please list:
If you are familiar with our space, tell us which meeting room(s) you will require:
Activity Title:
	If your request involves meeting space only, please skip to the end of the form to SUBMIT.
	If your request involves mockup space, please answer these additional questions prior to submitting.
Please provide a concise one sentence description (25 words or less) of your activity.
If you are familiar with our space, please tell us which mockup space(s) you will require:
Name of project manager that will lead and coordinate your project:
Which department(s) will be involved:
Will clinical frontline staff be involved? Specify roles:
Will members be involved?
Will equipment or technology need to be brought into the center for your activity? If so, which vendors?

	Tours are available by appointment only. If a tour is desired during your activity, be sure it is included as part of your request.
	Select this box to make your feedback email marked as urgent.



Your message is being sent to sherry.a.fry@kp.org

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Garfield Center Activity Request

Please submit answers to these questions. You will be confirmed via email and provided with additional logistics information.

Requesting Person's Name:

Phone Number:

Email Address:

Sponsoring Person's Name:

Sponsoring Person's Department (no acronyms):

Sponsoring Person's Region:

Date and Time of Proposed Activity (including setup time):

How many people be involved:

Which region(s) will be involved:

Does your group contain any non-KP employees (consultants, vendors or contractors)? If so, please list:

If you are familiar with our space, tell us which meeting room(s) you will require:

Activity Title:

Please provide a concise one sentence description (25 words or less) of your activity.

If you are familiar with our space, please tell us which mockup space(s) you will require:

Name of project manager that will lead and coordinate your project:

Which department(s) will be involved:

Will clinical frontline staff be involved? Specify roles:

Will members be involved?

Will equipment or technology need to be brought into the center for your activity? If so, which vendors?