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* 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
Audio Cassette Player
Compact Disc Player
Tape Player/Recorder
Boombox (CD/Tape)
P.A. System with Microphones
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
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
Overhead Projector (for transparencies)
Data/Video Projector
35mm Slide Projector
Other Projection
Other Services/Personnel
Equipment Demonstration
Podcasting Equipment
Training
Operator for Audio Recording
Operator for Video Recording
Operator for Event
Laptops
PC Laptop
Mac Laptop
Notes
Special Instructions
