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CLIENT INFORMATION

Name:*
Phone:*
E-mail address:*
Department/Faculty:*
Credit Course #:
FOAP/PO # (applicable for special events only) :
Payment Option:

EVENT INFORMATION

Start Date:     End Date:

Start Time:   End Time:

Please indicate day of the week for repeat requests:

Monday   Tuesday   Wednesday   Thursday   Friday   Don't Repeat

LOCATION

Building:*
Room#:*  

SERVICES & EQUIPMENT REQUIRED

Setup    Setup / Start  Operate  User Pickup & Return 
Technology Demonstration

Equipment
Laptop Computer Data Projector w/ DVD/VCR and Powered Speaker
Document Camera
Services
Video/Audio Recording (Digital Format)       Videoconference       Sound System
Master Digital Disc       Digital File (VOD)       Live Webcast (streaming)      
Photography/Imaging      
Additional Information: