Center for Connected Medicine Event Request Form

Please fill in all fields below to request space for an event at the Center for Connected Medicine (CCM). The CCM team will review all event requests and respond by email.

First Name *

Last Name *

Company/Department *

Email *

Title of Event or Meeting *

Name of UPMC Executive Sponsor *

Date of Event *

Is this date flexible? * YesNo

Is food/beverage needed for this event? * YesNo

Start Time *

End Time *

Estimated Attendance (Number only) *

Briefly describe your event: *

Comments