Equipment Check-out /Pick-up Request Form

Advance notice is required for LCD projectors and laptop computers.
1-day loan for camcorders and voice-recorders
2-day checkout for other equipment  s
3-day loan for Clicker


******** Please Read Carefully ********

Policy of Using Media Equipment

By filling out the form below, I (the requester) understand the equipment is for use by college functions only. I agree to take responsiblity for the condition and return of all equipment that will be checked out per this request; in the event that the equipment is missing or damaged, I agree to pay for the replacement or repair costs. In addtion, I agree to pay a $3 per day late fee for every piece of equipment not returned by 5:00 pm on the due date.

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When is the equipment needed?
Date time ...

When will you pick up the equipment?
Date: Time:

Location of equipment usage:
Building: Choose one... OFF CAMPUS Blackwell Auditorium Brock Center Brown Campus Center Copley Science Center Estes Hall-Hughes Room Estes Hall-Trustees Room Fox Hall Haley Hall McGraw-Page Library Old Chapel Pace-Armistead Hall Peele Hall Thomas Branch Hall Washington-Frank. Hall Other (please specify) Room:

Please describe the R-MC FUNCTION for which the equipment will be used. (Example: DVD viewing by the Campus Activity Board). Note we do NOT check out equipment for non-college events.

Please list all the equipment you are requesting:

Any other factors that may help to serve you better? (such as network, wireless mouse etc).

Will you need instruction on equipment use? Note: you must schedule a training session in advance with the MIS staff if you plan to borrow the Canon Digital SLR image camera.
YES...... NO

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