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40 UP MEDICINE STUDENT COUNCIL


External Affairs Committee

Free Room Use Slip

40 UP MEDICINE STUDENT COUNCIL


External Affairs Committee

Free Room Use Slip


Date:______________

Organization/Fraternity/Sorority:
_______________________________________________________
Room to be used:
_______________________________________________________
Date and Time of Use:
_______________________________________________________
Purpose:
_______________________________________________________

Requested by:

______________________

Checked by:

______________________
UP MSC External Affairs

Noted and Approved by:

Madeleine Sumpaico, MD
Associate Dean for Faculty and Students, UPCM


Date:______________

Organization/Fraternity/Sorority:
_______________________________________________________
Room to be used:
_______________________________________________________
Date and Time of Use:
_______________________________________________________
Purpose:
_______________________________________________________

Requested by:

______________________

Checked by:

______________________
UP MSC External Affairs

Noted and Approved by:

Madeleine Sumpaico, MD
Associate Dean for Faculty and Students, UPCM


th
40 UP MEDICINE STUDENT COUNCIL
External Affairs Committee

Free Room Use Slip


Date:______________

Organization/Fraternity/Sorority:
_______________________________________________________
Room to be used:
_______________________________________________________
Date and Time of Use:
_______________________________________________________
Purpose:
_______________________________________________________

Requested by:

______________________

Checked by:

______________________
UP MSC External Affairs

Noted and Approved by:

Madeleine Sumpaico, MD
Associate Dean for Faculty and Students, UPCM


th
40 UP MEDICINE STUDENT COUNCIL
External Affairs Committee

Free Room Use Slip


Date:______________

Organization/Fraternity/Sorority:
_______________________________________________________
Room to be used:
_______________________________________________________
Date and Time of Use:
_______________________________________________________
Purpose:
_______________________________________________________

Requested by:

______________________

Checked by:

______________________
UP MSC External Affairs

Noted and Approved by:

Madeleine Sumpaico, MD
Associate Dean for Faculty and Students, UPCM

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