Pediatric Hospital Medicine (PHM) Meeting 2018: AV Request Form

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* 1. Speaker Full Name

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* 2. Session Title

Rooms will be set theater style, with a screen, laptop, LCD projector, 2 microphones, and head table with 2 chairs. If you have additional AV needs or would like to request a different room set-ip, please indicate your needs in the question below.

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* 3. Please indicate any additional AV needs that you may have. Select all that apply.

Flip chart with markers

Sound Patch (This will give the audience capability to hear audio that may be included in your presentation.)

Additional microphones (indicate type and number in the "other" field)

Additional chairs for head table (indicate number in the "other" field)

Other (please specify)

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* 1. Speaker Full Name

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* 2. Session Title

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* 3. Please indicate any additional AV needs that you may have. Select all that apply.

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* 4. If needed, please indicate any special room set-up request in the field below.