KU Wichita: Clinical Skills Lab - Models; Spine model

Models
Spine Model - Lumbar	Reserve Item Back to Home Page
	Vertebrae only Plastic model of L-spine vertebrae

To reserve this item, please provide the following information. Required fields are in bold.
Contact Person Reserving Item:
*First name*
*Last name*
*Affiliation*
*Department*
*Work Phone*
*E-mail*		-- include complete address (ttess@kumc.edu)
Faculty Responsible for Item (if different than above):
First name
Last name
Department
Choose Audience & Location:
*Intended Audience*
	If other, please specify:
*Location for Use*
	Specify location:
Dates:
*Enter the date needed*	-- mm/dd/yy
Enter the return date	-- mm/dd/yy
Items to be Reserved:
If available, the following item will be reserved in your name. To reserve additional items, add them in this box:	Models: Spine Model - Lumbar
Note:
After you submit, you will receive a copy of this request in your e-mail. We will confirm if the item is available in a separate e-mail to the contact person listed on this form.

Last Modified: February 11, 2002
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Models