Requestor Name and Title Attachments Upload One file only.5 MB limit.Allowed types: gif, jpg, jpeg, png, eps, tif, psd, txt, rtf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml.. Event Type Tour Class Faculty-Led Class Outreach Program Individual Training SEAL-Led Lab Contact Phone Number Contact Email Duke Affiliation Request Date Request Start Time Requested Duration minutes How Many Learners? Tech Support? Yes No How Long? minutes Rooms Needed: Mannequin Lab Surgical Lab Small Conference Room Large Conference Room Simulators to Be Used: Adult High Fidelity Mannequin (iStan) Ultrasound Simulator (Vimedix) Neonate Mannequin (SimBaby) Adult High Fidelity Mannequin (TraumaMan) Laparoscopic Trainer (Box) Endoscopic Trainer (GI Mentor) Robotic Surgery Trainer (Da Vinci XI-SimNow) Endovascular Simulator (AngioMentor) Catering Needs AV Needs List ALL Other Supplies Needed (Tables, Chairs, etc.) Brief Description of Activity Submit
