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SUPPLIES & RESOURCES RESERVATION

If you have any questions, please contact Tina Lengle at 531-0003 ext. 285929 or tlengle@hmc.psu.edu.

* 1. First and Last Name

* 2. Email Address

* 3. Phone Number

* 4. Your role/position at the medical school (e.g. 1st year medical student, 4th year nursing student, assistant professor, etc)

5. MEDICAL SUPPLIES: Please indicate which items you wish to reserve. The number in parenthesis indicates the quantity available.

6. How long would you like to reserve this item/these items?

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7. Comments: Indicate the intended purpose of the item(s).

8. How long would you like to reserve this item/these items?

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9. Comments: Indicate the intended purpose of the item(s).

10. OFFICE SUPPLIES: Please indicate which items you wish to reserve. The number in parenthesis indicates the quantity available.

11. How long would you like to reserve this item/these items?

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12. Comments: Indicate the intended purpose of the item(s).

13. LITERATURE: Please indicate which items you wish to reserve. The number in parenthesis indicates the quantity available.

14. How long would you like to reserve this item/these items?

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15. Comments: Indicate the intended purpose of the item(s).

16. DVDs: Please indicate which items you wish to reserve. The number in parenthesis indicates the quanity available.

17. How long would you like to reserve this item/these items?

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18. Comments: Indicate the intended purpose of the item(s).

19. CD-ROMs: Please indicate which items you wish to reserve. The number in parenthesis indicates the quantity available.

20. How long would you like to reserve this item/these items?

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21. Comments: Indicate the intended purpose of the item(s).

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