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BOOKING FORM
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Email
*
Your email
UiTM:
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Student
Lecturer
Staff
Name :
*
Your answer
Student / Staff number
*
Your answer
Posting / Department
*
Your answer
Contact number
*
Your answer
Reason for booking
*
Class / Practical session
Examination
Other:
Date of booking
*
MM
/
DD
/
YYYY
Time start
*
Time
:
AM
PM
Time end
*
Time
:
AM
PM
Room / area
*
Lecture Hall
Simulation room/area
Speaker's Lounge / Meeting room
Required
Please indicate the set up, bed/couch, manikin and equipment required
Your answer
Thank you for your interest in UiTM Simulation Centre
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