A/V Equipment Request Form

Revised: February 22, 2013

For all Bookings
Today's Date:			Date Required:
Time From:		Time To:		Room #:
Faculty Name:			Student Name:
Phone #:		E-Mail:
For Semester Booking Only
Start Date:		End Date:		Total Wks:
Equipment Requested
Video	Blu-Ray Player Camera Digital Still Camera Flip (hard drive) Camera mini DVD Camera Samsung (hard drive) Data Video Projector with Computer (pick-up only) Data Video Projector (connect to own laptop) Document Camera DVD/VHS player w/monitor on cart Overhead Projector Projector Screen Smart Board Wacom Bamboo Tablet
Audio	Chattervox (Portable P.A.) Digital Voice Recorder Portable CD/MP3 Player Portable Speakers Public Address System
Accessories	Extension Cord Flip Chart Power Point Remote Tripod Turning Point Remotes Kit (25 per Kit) Whiteboard Whiteboard/Arrow Sign Stand Other: