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BOOKING FORM
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Email
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Your email
UiTM:
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Student
Lecturer
Staff
Name
*
Your answer
Student / Staff number
*
Your answer
Posting / Department
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Your answer
Contact number
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Your answer
Reason for booking
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Class / Practical session
Examination
Other:
Date
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MM
/
DD
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YYYY
Time start
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Time
:
AM
PM
Time end
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Time
:
AM
PM
Approximate number of attendees:
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Your answer
Year of Posting (eg. Year 1/2/3/4/5)
Your answer
Room / area
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Lecture room/ Debriefing room
Critical care area
Basic Life Support area
Ward simulation area
Focused Skill Station
Sono Room
Bedside Teaching (BST)
Pantry
Required
Please indicate the set up, bed/couch, manikin and equipment required
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Thank you for your interest in UiTM Simulation Centre Sungai Buloh
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