Today's Date:	(mm/dd/yyyy)
Person submitting request:
Event:		Phone #:
Date of Event:	(mm/dd/yyyy)	Location:
Start Time:		End Time:
Contact Person:		Phone #:
Equipment Requested (select all that apply)
TV/VCR	Large Screen	Party Lights
Slide Projector	Portable Screen	Podium
Overhead Projector	PA System	# of Mics Needed
Video Camera	Cassette Deck	# of Mic Stands Needed
Video Projection Unit	CD Player
Portable CD/cassette player	DJ Equipment	Video Tape Event
Please describe the event in the space below.
* Media Center Staff will take care of setup and teardown of equipment for most events. *
The Media Center requires at least a 24 hour notification prior to an event. The Media Center will try to accommodate all requests, but please be aware that certain circumstances and conflicts with other events may arise.