EmailMe Form - Laboratory Equipment Reservation

Name *

First Last

School Name *

School District *

School Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Email *

Reservation Information

Please choose the date (along with an alternate date) you would like to request delivery/pick up of the equipment and the date the equipment will be returned.

RSVP Request 1 Pick Up/Delivery Date *

MM / DD / YYYY

RSVP Request 1 Return Date *

MM / DD / YYYY

RSVP Request 2 Pick Up/Delivery Date *

MM / DD / YYYY

RSVP Request 2 Return Date *

MM / DD / YYYY

Equipment/Materials *

Number of GLXs/Sensors

RSVP Dates Terms and Conditions *

By checking this box I understand that the dates requested may not be available and I may need to choose alternate dates.

Transportation Terms and Conditions *

I agree that I will arrange for pickup and return of the equipment no later than the Return Date. I understand that the SFU Science Outreach Center will contact me in the event that SFU can deliver and/or return the equipment.