Lab Space Request Form

Complete the form below or click OLC LAB Request Form to upload a PDF version that you can complete and send in at your convenience.

Dates Requested:

Site Visit:

Please call to schedule

Organization:

Billing Address:

Organization Contact:

Phone Number:

Email:

Cell Number:

How did you hear about the OLC?

Set Up Date and Time:

Date(s) & Hours of Meeting:

# of People:

Title of Event/Meeting:

LAB INFORMATION
Lab Space includes Lab A – 12 Stations, Lab B – 12 Stations or both Lab A & B – 24 Stations
Demo Station – For presenting Live Demonstrations in Lab(s), Auditorium(s), Conference Room(s) or Outside Venues

LAB REQUIREMENTS

# of Station(s):

# Staff:

# Registrants:

# Reps:

# Faculty:

Demo Station

Type of Meeting/Procedure (i.e. ACL repair, Pain management etc.):

Open Procedure
Arthoscopic/Endoscopic
Other:

If you selected "Other", explain below:

SPECIMEN SUPPORT

Type of Specimen

Type of Specimen:

# of Specimens:

Specimen Position and is positioning device required? Please specify below:

Specimen Position Details:

Will CT scan or MRI be required on specimen(s) prior to the course? Please specify any details (additional fee):

CT scan or MRI Details:

C-ARM REQUIREMENTS:

Mini C-Arm(s)

C-Arm(s)

# of Mini C-Arms

(additional fees)

# of C-Arms

(additional fees)

Specific Date(s) & Hours for C-Arm Tech:

(If you need more than 2 Mini C-Arms or 2 C-Arms, you will need to make the necessary arrangements to have them shipped in.)

INSTRUMENTATION REQUIRED:

(Detailed list of instrumentation available upon request.)

POWER EQUIPMENT (additional fees for blades):

Stryker Drills

Stryker Reciprocating Saw

Stryker Sagital Saw

Please choose (adapters required):

Jacobs Chuck
Synthes
Hudson

List Size of Blades Needed (Reciprocating)

List Size of Blades Needed (Sagital)

Compressed Air (additional fees)
Suction Capabilities (additional fees)

LAB AV REQUIREMENTS:

Session(s) Recorded (additional fees)
LCD (additional fees)
Streaming/Webcasting (additional fees)
Easels
Flipcharts (additional fees)

Teleconferencing (additional fees):

Conference Phone

Videoconferencing (additional fees):

Outbound Locations
Inbound Transmission

ADDITIONAL EVENT/MEETING SPACE REQUIRED (additional fees):

Auditorium A - Classroom - 72pp
Auditorium B - Classroom - 72pp
Auditorium C - Classroom - 36pp
Auditorium AB - Classroom -144pp
Auditorium BC - Classroom - 108pp
Auditorium ABC - Classroom - 180pp
Conference Room 1A - Hollow square - 16pp
Conference Room 1B - Conference - 8pp
Conference Room 1A/B - Hollow square - 24pp

EVENT/MEETING SPACE AV REQUIREMENTS:

Session(s) Recorded (additional fees)
LCD (additional fees)
3D Projector (Auditorium C Only) (additional fees)
Streaming/Webcasting (additional fees)
Easels
Flipcharts (additional fees)

Teleconferencing (additional fees):

Conference Phone

Videoconferencing (additional fees):

Outbound Locations
Inbound Transmission

Please note: AV technician(s) required for space requested will be included in quote.

CATERING REQUIRED:

Yes
No

If catering is needed OLC staff will contact you with menu options and provide a separate estimate.

Special Meeting/Event Requirements:

Does your meeting or event have any special needs that we should be aware of?

EVENT MATERIALS REQUIRED BY OLC:

Participant Registration List
Meeting/Event Daily Agenda
Lab Participant Waiver Form (form is for anyone entering the Lab space and is available on-site.)

I will be held responsible by the OLC Education and Conference Center for all requested information as specified above.

I agree

Date: