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Order Form
| Schedule an Event
Please submit equipment request
at least 2 business days prior to the event.
Print this form
* denotes required field
Contact Information
Contact Name *
Contact Mailing Address *
Department *
School *
Contact Phone Number *
Contact Fax Number
Contact Email Address *
User Same as Contact
User Name *
User Phone Number *
User Fax Number
User Email Address *
Account Information
Events Media Services operates on a cost-recovery basis, therefore a valid account number is required.
Account Number
Billing Information
Billing Officer
Billing Phone
Billing Officer Email
Event Information
Event Title
Event Description
Location
Building
Room
Date(s) and Time(s)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Begin Date
Select Start Date from Calendar
End Date
Select End Date from Calendar
Start Time
Actual Start Time of Event
(e.g. 11:00am)
End Time
Actual End Time of Event
Event Services and Equipment
Audio
Play Back
Cassette
CD
Boombox
iPod/Laptop (1/8" Mini Stereo Cable)
Record
Cassette
CD
Digital
Please indicate microphones needed.
Podium (Wired)
1
2
3
4
5
6
7
8
9
10
Podium (Wireless)
1
2
3
4
5
6
7
8
9
10
On Table (Wired)
1
2
3
4
5
6
7
8
9
10
On Table (Wireless)
1
2
3
4
5
6
7
8
9
10
On Floor Stand (Wired)
1
2
3
4
5
6
7
8
9
10
On Floor Stand (Wireless)
1
2
3
4
5
6
7
8
9
10
Clip-on Mic (Wireless)
1
2
3
4
5
6
7
8
9
10
Video
Video Simulcast
Digital Video Camera/Tripod
1st Location for Simulcast
2nd Location for Simulcast
Video Playback
Video Playback VHS
Video Playback DVD
Foreign Video Playback VHS
Foreign Video Playback DVD
DVD/VCR Remote Required
Projection
Data/Video Projector
35mm Slide Projector
52" Flat Panel Monitor
Will you require Audio Playback with your video projection?
(Check for Yes)
Laptops
PC Laptop
Mac Laptop
Other Services
Equipment Demonstration
Operator for Audio Recording
Mac Adapter
Operator for Event
Mac Model
Notes
Special Instructions
This is my personal computer, please remember my information for next time.
