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?

Check-out:
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Expected Return:
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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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Expected Return:
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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?

Check-out:
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Expected Return:
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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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Expected Return:
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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?

Check-out:
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Expected Return:
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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?

Check-out:
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Expected Return:
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* 21. Comments: Indicate the intended purpose of the item(s).

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