Audio-Visual Request Form

Your Information
First Name:
Last Name:
Email:
Phone:
ESM Affiliation:	-Select- FacultyStudentStaffAdministrator
U of R campus:	-Select- EastmanMAGMedical CenterRiver CampusOther
Event Information
Event Name:
Event Location:
Please Note: As the T&MP Department lends equipment on a first-come, first-serve basis, it is best to reserve equipment at least one month in advance. There are no guarantees for equipment requested less than a week in advance.
When is this equipment needed?
Date equipment required:
Start time:
End time:
If you have reserved additional time for set-up and tear-down for your event, please specify:
Set-up time:
Tear-down time:
If you will require the equipment for the same time on different dates, please use the "Additional Information/Comments" box below to list other dates.
When reserving equipment in the evening or over a weekend, you are responsible for keeping equipment locked in a safe place while the office is closed and returning it as early as possible the next business day.
If you will require the equipment for a period of consecutive dates: please specify dates:
First Date:
First Time:
Last Date:
Last Time:
T&MP equipment is loaned for use on Eastman projects only. For what sort of event or project will this equipment be used?
Type of project or event:	-Select- Lecture Class project Concert or Recital Meeting Off-site meeting Recording session Off-site recording Other
If you indicated "Other," please explain:
Event specifics:
Equipment Information
Sound:	Boombox - description CD Player - description Computer Speakers - description Audio Cable - description Conference Call Equipment - description
Photography:	Digital Camera - description Tripod - description
Projection:	Overhead Projector - description Slide Projector - description Data Projector - Instructions • description VGA Cable - description Portable Screen - description
Video:	DVD Player - Region Free - description Laser Disc Player - description DVD/VCR Portable Unit - description Portable Media Cart - description (Television and DVD/VCR Combo Unit)
Audio Recording:	CDR Recorder with Microphone - CDR description- click for microphone description - Mini Disc Recorder - description
(Self-serve recording units located in Howard Hanson Hall and Ciminelli Hall do not need to be reserved seperately. For information, please click here.)
Video Recording:	VHS Camcorder - description DVD Camcorder - description Tripod - description
Computers:	Mac Laptop - description PC Laptop - description - MacAdapter - description (for connection to projectors) Internet Connection - description
Staff Assistance:	I require staff assistance for this event.
Delivery Options
Please select one:	This equipment should be delivered to the room I reserved. I will sign out this equipment from the T&MP office myself and I will return everything on time.
I understand that I am responsible for returning equipment in the same condition in which it was borrowed. I understand that I will be held financially responsible if a piece of equipment is lost, damaged or stolen. I agree that if I reserve equipment in the evening or over a weekend I am responsible for keeping equipment locked in a safe place while the T&MP office is closed, and I agree to return it as early as possible the next business day.
Click here:	I agree.
Additional information, comments or special requests:
*Enter code:

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