Audio and Visual Services Request Form Please use this form to request HSSEAS audio and visual services. * indicates required field Requester Name:* Your Full Name Requester Email:* An email address that we can use to contact you Requester Building:* BH EIV EV EVI Other Requester Room Number:* Requestor Phone Number:* Your phone number Authorized By:* The person who authorizes you to reserve AV equipment Authorization E-Mail:* The email address of the person authorizing the AV equipment reservation Recharge ID:* The Recharge ID we should use to charge you Event Type:* Lecture Meeting Seminar Oral Exam The type of your event If you select lecture above, what is the course number? The course number of the lecture Event Title:* The title of your event Delivery Date:* The date at which the audio/visual equipment should be delivered Delivery Time:* 01 02 03 04 05 06 07 08 09 10 11 12 : 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 AM PM The time at which the audio/visual equipment should be delivered Day(s) of Week Needed:* Monday Tuesday Wednesday Thursday Friday The day(s) of the week on which the equipment is needed Delivery Location:* The location at which the equipment should be delivered Return Date:* The date at which the equipment will be returned Return Time:* 01 02 03 04 05 06 07 08 09 10 11 12 : 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 AM PM The time at which the equipment will be returned Equipment Needed:* Digital Still Camera Digital Video Camera DVD/VCR Combination with Monitor Laptop Computer Overhead Projector Public Address System Portable Screen Slide Projector Tripod Video Data Projector Wireless Microphone Other - Please Specify Below The equipment that you need. You can select more that one equipment Special Instructions: If you need some special equipment that is not listed above, please specify it here
